Case reports
59
Rupture of muscle belly of the extensor carpi radialis longus J. J. Southgate and M. H. Stone Department
of Orthopaedics,
Southampton
General Hospital, Southampton,
Case report A lo-year-old labourer sustained transverse fractures of the radius and ulna with dorsal angulation (Figure I). There were superficial lacerations on the dorsum of the wrist and surgical emphysema extended proximally to the elbow. There was no neurovascular deficit. Wound toilet, fasciotomy and internal fixation of the radius and ulna were carried out. Proximal extension of the surgical wounds allowed exploration of the emphysema. The muscle belly of the extensor carpi radialis longus was found to be ruptured proximally and could be delivered into the wound in two parts. It did not contract or bleed when cut after release of the tourniquet and the complete muscle belly (IOcm x 4an) was excised. Its tendon was sutured to the extensor carpi radialis brevis. Secondary suture of the wound with skin grafting was carried out 5 days later. The patient made an
Figure I. Radiograph
at time of initial assessment.
$2 1992 Butterworth-Heinemann &20-1383/92iO10059-02
UK
uncomplicated recovery. At 8 months after this accident he had resumed his normal job of labouring, involving heavy lifting and use of handheld tools. His only complaint was of occasional swelling of the forearm which was relieved by tubigrip support. There was no clinical deformity and the wounds were healed. Wrist extension was full and his grip was normally powerful. There was a loss of 20” supination and 10” wrist abduction. A radiograph showed that the fracture had healed (Figure 2).
Discussion Despite reports in the literature that ECRL contributes significantly to the strength of wrist extension (Brand et al, 1981; Last, 1984), this patient had a good functional result after complete primary surgical excision of the muscle belly of the ECRL and tenodesis of its tendon to the extensor carpi radialis brevis. He returned to his normal working practices
Figure 2. Radiograph
at 6 months after injury
the British Journal of Accident Surgery (1992)Vol. 23/No.1 Injury:
60
and had no clinical evidence of a reduced power-grip. Traumatic ruptures of other extensor tendons have been widely reported in the literature and are usually associated
with Colles’ fracture or rheumatoid arthritis (Milch and Epstein, 1987). One report of delayed surgical repair of ECRL at 12 days reported residual weakness of wrist extension and grip power. There are no other reports in the literature of excision of the ECRL (Sadr and Lalehzarian,
Last
R. J. (1984)Anatomy, Regional and Applred, 7th Ed. London and Edinburgh: Churchill Livingstone. Traumatic rupture of extensor Milch E. and Epstein M. D. (1987) pollicis longus tendon. Ann. Pht. Sqg. 19, 460. Sadr B.and Lalehzarian M. (1987) Traumatic avulsion of tendon of extensor carpi radialis longus. 1. Hana’ Surg. 12A, 1035.
1987). Paper accepted
17 May
1991
References Brand P. W., Beach R. B. and Thompson D. E. (1981) Relative tension and potential excursion of muscles in forearm and hands. 1. Hand Surg. 6,209.
Requests fur reprints should be addresd
General Surgery, Queen mouth PO6 3LY. UK.
Alexandra
fa
Dr. 1.1. So&gate,
Hospital,
Cosham,
SHO Ports-
Traumatic hip dislocation with ipsilateral femoral shaft fracture in a child: an ‘open and closed’ case R. N. S. Slater and P. R. Allen Orthopaedic
and Trauma Surgery Unit, Lewisham Hospital, London, UK
Case report A I.&year-aid boy was struck on the feft thigh by a car travelling at about 30mph. On examination in hospital, the left leg lay adducted and internally rotated. The thigh was swollen. A radiograph confirmed femoral shaft fracture with posterior dislocation of the hip (Figure I). With minimal delay the patient was anaesthetized. but attempted closed reduction of the dislocation failed because of inadequate purchase on the proximal fragment. Open reduction and internal fixation of the fracture was performed using an a-hole dynamic compression plate. The dislocation then reduced easily in the usual way (Figure 2). Movements of the patient were limited for the first 3 weeks postoperatively by skin traction to allow tears in the hip capsule to heal. At 6 months after the injury, union of the fracture was confirmed by radiography, and bone scintigraphy revealed normal vascularity of the femoral head.
Discussion Traumatic hip dislocation with ipsilateral femoral shaft fracture is very rare, and rarer still in a child (Malkawi, 1982); many trauma surgeons will not see a case in their working lifetime. The dislocation may be missed (Helal and Skevis, 1967). We stress the importance of awareness of this combination of injuries and of obtaining adequate radiographs of joints proximal and distal to long bone fractures. .$“ 1992 Butterworth-Heinemann
0020-13&33/92/01006&02
Ltd
Figure I. Radiograph on admission showing ture and posterior dislocation of the hip.
femoral shaft I&C-
59
Rupture of muscle belly of the extensor carpi radialis longus J. J. Southgate and M. H. Stone Department
of Orthopaedics,
Southampton
General Hospital, Southampton,
Case report A lo-year-old labourer sustained transverse fractures of the radius and ulna with dorsal angulation (Figure I). There were superficial lacerations on the dorsum of the wrist and surgical emphysema extended proximally to the elbow. There was no neurovascular deficit. Wound toilet, fasciotomy and internal fixation of the radius and ulna were carried out. Proximal extension of the surgical wounds allowed exploration of the emphysema. The muscle belly of the extensor carpi radialis longus was found to be ruptured proximally and could be delivered into the wound in two parts. It did not contract or bleed when cut after release of the tourniquet and the complete muscle belly (IOcm x 4an) was excised. Its tendon was sutured to the extensor carpi radialis brevis. Secondary suture of the wound with skin grafting was carried out 5 days later. The patient made an
Figure I. Radiograph
at time of initial assessment.
$2 1992 Butterworth-Heinemann &20-1383/92iO10059-02
UK
uncomplicated recovery. At 8 months after this accident he had resumed his normal job of labouring, involving heavy lifting and use of handheld tools. His only complaint was of occasional swelling of the forearm which was relieved by tubigrip support. There was no clinical deformity and the wounds were healed. Wrist extension was full and his grip was normally powerful. There was a loss of 20” supination and 10” wrist abduction. A radiograph showed that the fracture had healed (Figure 2).
Discussion Despite reports in the literature that ECRL contributes significantly to the strength of wrist extension (Brand et al, 1981; Last, 1984), this patient had a good functional result after complete primary surgical excision of the muscle belly of the ECRL and tenodesis of its tendon to the extensor carpi radialis brevis. He returned to his normal working practices
Figure 2. Radiograph
at 6 months after injury
the British Journal of Accident Surgery (1992)Vol. 23/No.1 Injury:
60
and had no clinical evidence of a reduced power-grip. Traumatic ruptures of other extensor tendons have been widely reported in the literature and are usually associated
with Colles’ fracture or rheumatoid arthritis (Milch and Epstein, 1987). One report of delayed surgical repair of ECRL at 12 days reported residual weakness of wrist extension and grip power. There are no other reports in the literature of excision of the ECRL (Sadr and Lalehzarian,
Last
R. J. (1984)Anatomy, Regional and Applred, 7th Ed. London and Edinburgh: Churchill Livingstone. Traumatic rupture of extensor Milch E. and Epstein M. D. (1987) pollicis longus tendon. Ann. Pht. Sqg. 19, 460. Sadr B.and Lalehzarian M. (1987) Traumatic avulsion of tendon of extensor carpi radialis longus. 1. Hana’ Surg. 12A, 1035.
1987). Paper accepted
17 May
1991
References Brand P. W., Beach R. B. and Thompson D. E. (1981) Relative tension and potential excursion of muscles in forearm and hands. 1. Hand Surg. 6,209.
Requests fur reprints should be addresd
General Surgery, Queen mouth PO6 3LY. UK.
Alexandra
fa
Dr. 1.1. So&gate,
Hospital,
Cosham,
SHO Ports-
Traumatic hip dislocation with ipsilateral femoral shaft fracture in a child: an ‘open and closed’ case R. N. S. Slater and P. R. Allen Orthopaedic
and Trauma Surgery Unit, Lewisham Hospital, London, UK
Case report A I.&year-aid boy was struck on the feft thigh by a car travelling at about 30mph. On examination in hospital, the left leg lay adducted and internally rotated. The thigh was swollen. A radiograph confirmed femoral shaft fracture with posterior dislocation of the hip (Figure I). With minimal delay the patient was anaesthetized. but attempted closed reduction of the dislocation failed because of inadequate purchase on the proximal fragment. Open reduction and internal fixation of the fracture was performed using an a-hole dynamic compression plate. The dislocation then reduced easily in the usual way (Figure 2). Movements of the patient were limited for the first 3 weeks postoperatively by skin traction to allow tears in the hip capsule to heal. At 6 months after the injury, union of the fracture was confirmed by radiography, and bone scintigraphy revealed normal vascularity of the femoral head.
Discussion Traumatic hip dislocation with ipsilateral femoral shaft fracture is very rare, and rarer still in a child (Malkawi, 1982); many trauma surgeons will not see a case in their working lifetime. The dislocation may be missed (Helal and Skevis, 1967). We stress the importance of awareness of this combination of injuries and of obtaining adequate radiographs of joints proximal and distal to long bone fractures. .$“ 1992 Butterworth-Heinemann
0020-13&33/92/01006&02
Ltd
Figure I. Radiograph on admission showing ture and posterior dislocation of the hip.
femoral shaft I&C-
