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Screw Impingement on the Extensor Tendons in Distal Radius Fractures Treated by Volar Plating: Sonographic Appearance

Stefano Bianchi1, Jan van Aaken2, Thierry Glauser3, Carlo Martinoli4, Jean-Yves Beaulieu2 and Dominique Della Santa2

1 Institut de Radiologie, Clinique des Grangettes, 7 Chemin des Grangettes, 1224 Geneva, Switzerland.
2 Departemente de Orthopedie, Hôpital Universitaire de Geneve, Geneva, Switzerland.
3 Centre de Chirurgie et de Thérapie de la Main, Geneva, Switzerland.
4 Cattedra di Radiologia, DICMI, Università di Genova, Genova, Italia.


Figure 1
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  		Fig. 1 —Axial schematic drawing shows that 12 extensor tendons of wrist (a–i) run inside six fibroosseous tunnels (1–6) numbered from lateral to medial. a = abductor pollicis longus, b = extensor pollicis brevis, c = extensor carpi radialis longus, d = extensor carpi radialis brevis, e = extensor pollicis longus, f = extensor indicis proprius, g = extensor digitorum communis, h = extensor digiti minimi, i = extensor carpi ulnaris, LT = Lister tubercle.

 

Figure 2
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  		Fig. 2A —In vitro appearance of a volar plate screw. Sonogram obtained over screw tip (arrow) shows that thread (arrowheads) appears as multiple oblique parallel hyperechoic lines.

 

Figure 3
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  		Fig. 2B —In vitro appearance of a volar plate screw. Corresponding photograph of examined screw shows tip (arrow) and thread (arrowheads).

 

Figure 4
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  		Fig. 3A —In vivo sonography appearance of screw tip impingement on extensor tendons in 66-year-old woman who had undergone volar plating for distal radius fracture (patient 8 in Table 1). Transverse sonogram obtained over dorsal distal epiphysis of radius shows tips of small (small arrow) and large (large arrow) screws (cursors) protruding inside third and fourth extensor compartments. Extensor tendons (ETs) are located close to tips and are surrounded by thickened synovium. LT = Lister tubercle.

 

Figure 5
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  		Fig. 3B —In vivo sonography appearance of screw tip impingement on extensor tendons in 66-year-old woman who had undergone volar plating for distal radius fracture (patient 8 in Table 1). Sagittal sonogram obtained over fourth extensor compartment shows close relation of large screw tip (arrow) and extensor tendons (ETs). Note hypoechoic, thickened synovium (arrowheads) surrounding tendons. Lun = lunate bone.

 

Figure 6
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  		Fig. 3C —In vivo sonography appearance of screw tip impingement on extensor tendons in 66-year-old woman who had undergone volar plating for distal radius fracture (patient 8 in Table 1). Photograph obtained during surgical exploration confirms screw tip (black arrow) is protruding inside fourth extensor compartment. Note distal stump of torn extensor indicis proprius tendon (white arrow). ETs = extensor tendons.

 

Figure 7
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  		Fig. 4A —61-year-old woman with history of volar plating for distal radius fracture who presented with screw impingement on extensor tendons and tenosynovitis (patient 2 in Table 1). Transverse sonogram obtained over dorsal aspect of wrist shows tenosynovitis of extensor tendons (ETs). Note anechoic effusion (black arrowhead) and hypertrophy of synovium (white arrowheads) filling tendon sheath.

 

Figure 8
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  		Fig. 4B —61-year-old woman with history of volar plating for distal radius fracture who presented with screw impingement on extensor tendons and tenosynovitis (patient 2 in Table 1). Corresponding transverse color Doppler sonogram depicts hyperemic changes within inflamed tendon sheath. ETs = extensor tendons.

 

Figure 9
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  		Fig. 5A —71-year-old woman with screw impingement on extensor tendons and complete tear of extensor pollicis longus tendon (patient 3 in Table 1). Sagittal sonograms obtained over proximal (A) and distal (B) stump show retracted hypoechoic, swollen tendon stumps (asterisks). Tendon sheath (arrowheads, A) located between stumps contains debris and small effusion. ETs = extensor tendons. In B, ECRL indicates extensor carpi radialis longus muscle and ECRB, extensor carpi radialis brevis muscle.

 

Figure 10
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  		Fig. 5B —71-year-old woman with screw impingement on extensor tendons and complete tear of extensor pollicis longus tendon (patient 3 in Table 1). Sagittal sonograms obtained over proximal (A) and distal (B) stump show retracted hypoechoic, swollen tendon stumps (asterisks). Tendon sheath (arrowheads, A) located between stumps contains debris and small effusion. ETs = extensor tendons. In B, ECRL indicates extensor carpi radialis longus muscle and ECRB, extensor carpi radialis brevis muscle.

 

Figure 11
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  		Fig. 5C —71-year-old woman with screw impingement on extensor tendons and complete tear of extensor pollicis longus tendon (patient 3 in Table 1). Transverse sonograms obtained over retracted proximal stump (asterisk, C) and at level of Lister tubercle (LT, D). In D, note empty tendon sheath (arrowhead) and extensor tendons (ETs).

 

Figure 12
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  		Fig. 5D —71-year-old woman with screw impingement on extensor tendons and complete tear of extensor pollicis longus tendon (patient 3 in Table 1). Transverse sonograms obtained over retracted proximal stump (asterisk, C) and at level of Lister tubercle (LT, D). In D, note empty tendon sheath (arrowhead) and extensor tendons (ETs).

 

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