Author(s): Rui Cró Freitas, André Chambel, Hilário Alcântara, Graça Lopes and Ana Sofia Lima

Abstract: Forearm fractures are among the most common orthopedic injuries in children, accounting for approximately 40 percent of all pediatric fractures. While the majority of these fractures are treated non-surgically, surgical intervention has become more frequent for cases where reduction cannot be maintained or in cases of open fractures. Elastic Stable Intramedullary Nailing has become a preferred surgical method for its minimally invasive nature. However, complications, including infections, delayed bone healing, and, notably, delayed rupture of the extensor pollicis longus tendon, though uncommon, present challenges. The choice of entry point, either dorsal or lateral, plays a critical role in determining risk, as a dorsal approach may endanger the extensor pollicis longus tendon. This case illustrates a complication of delayed extensor pollicis longus tendon rupture following elastic nailing.An eight-year-old boy sustained a midshaft radius fracture from a fall. After unsuccessful conservative management, elastic nailing was performed using a dorsal entry point near Lister’s tubercle. Two months post-surgery, the child experienced a sudden inability to extend the thumb, diagnosed as a complete rupture of the extensor pollicis longus tendon. Surgical exploration revealed the tendon had ruptured due to continuous abrasion against the sharp end of the nail. The rupture was managed by transferring the extensor indicis proprius tendon to restore thumb extension. Following a structured rehabilitation program, the child achieved full recovery of thumb function without further complications. This case underscores the importance of considering potential complications associated with elastic nailing in pediatric forearm fractures, specifically the risk of delayed rupture of the extensor pollicis longus tendon. Careful selection of the surgical entry point and meticulous surgical technique are crucial to minimizing tendon injury. This case supports the consideration of lateral entry points in applicable cases to reduce the risk of delayed tendon complications.

DOI: 10.22271/27078345.2024.v6.i2b.230

Pages: 102-105 | Views: 59 | Downloads: 21

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