Avulsion fracture of the second metacarpal base by the extensor carpi radialis longus

[Avulsion of the extensor carpi radialis longus et brevis tendons with avulsion fracture at the base of the third metacarpal bone : A rare case]

This article presents the case of a traumatic avulsion of the extensor carpi radialis longus et brevis tendons with avulsion fracture at the base of the third metacarpal bone. Surgery as soon as possible is recommended in order to avoid retraction of the tendon.

Diagnosis of isolated extensor carpi radialis longus (ECRL) tendon avulsion fracture using ultrasound: a paradigm shift

Isolated avulsion fracture of the extensor carpi radialis longus (ECRL) tendon is a rare and poorly understood injury. We present a unique case of a 45-year-old male who fell on his flexed right hand. He presented with a subtle but extremely painful mass on the dorsum of his wrist. Ultrasound (U/S) imaging of the mass revealed an avulsed bone fragment attached to the ECRL tendon, confirming the clinical suspicion of an ECRL avulsion injury. Computed tomography and magnetic resonance imaging are well-documented imaging modalities to detect tendon avulsions. As demonstrated by this case report, U/S is an excellent diagnostic tool for ECRL rupture, a cost-effective alternative that provides real-time dynamic examination of hand injuries. To our knowledge, this is the first case of ECRL avulsion diagnosed by U/S. The purpose of this case report is to educate the reader on detection and diagnosis of ECRL tendon avulsion using U/S, a time-efficient and cost-effective imaging modality that is infrequently used for this purpose.

Avulsion Fractures at the Base of the 2(nd) Metacarpal Due to the Extensor Carpi Radialis Longus Tendon: A Case Report and Review of the Literature

Introduction:

Simultaneous contraction of the extensor carpi radialis longus (ECRL) with forced hyperflexion of the wrist can result in avulsion of the tendon and its bony attachment at its insertion at the dorsum of the base of the second metacarpal. This is a rare and often unreported fracture pattern.

Case Presentation:

We present a 31- year- old male who sustained a hyperflexion injury. He was managed surgically and had good post-operative outcomes. A literature search revealed 16 papers covering 18 cases of similar injuries. 12 were initially managed surgically and 6 were managed conservatively.

Conclusions:

Of the open reductions and internal fixations, 11 (92%) were successful and patients made a full recovery. Conservative management was unsuccessful in 4 cases; one patient required surgery for metacarpal boss, one patient had retraction of the tendon at one week follow up and another had weak flexion of the wrist. We recommend open reduction and internal fixation for these injuries. It may allow a faster recovery and therefore allow an earlier return to work and activity.

[Bony avulsion of the extensor carpi radialis longus tendon from the base of the second metacarpal: A rare injury]

We report on a 19-year-old male patient with a rare injury: a basis fracture of the second metacarpal with avulsion of the extensor carpi radialis longus (ECRL) tendon. The patient was treated with open reduction and internal plate fixation of the fragment. The functional results after 10 months of follow-up were pronation/supination 90/0/90° (90/0/90°), extension/flexion 70/0/70° (70/0/70°) radial/ulnar duction 20/0/40° (25/0/40°), bilateral grip strength was 115 kPa. The patient suffered no pain at all. The Mayo wrist score reached 100 points. Radiologically, the fracture was consolidated.Consistent diagnostics and surgical therapy lead to functional and radiological recovery following fracture of the second metacarpal base with avulsion of the extensor carpi radialis longus tendon.

Fracture-dislocations of the carpometacarpal joints of the ring and little finger

We report the functional and radiographic results of 16 patients with fracture-dislocations of the ring and little finger carpometacarpal joints and 23 cases with fracture-dislocations of only the little finger carpometacarpal joint treated between 2006 and 2012. The above two cohort populations of patients were treated with either open reduction and pin fixation or closed reduction and pin fixation. These patients were followed for a mean of 13 months (range 9 to 48). The DASH scores for patients with fracture-dislocations of the ring and little finger carpometacarpal joints were 6.0 and of the little finger carpometacarpal joint 7.2. We found no functional differences in term of DASH scores after treatment between patients with fracture-dislocations of only the little finger carpometacarpal joint and both the ring and little finger carpometacarpal joints.

Avulsion fracture of the extensor carpi radialis longus carpal insertion due to a basketball injury: case report and literature review

Articular fractures of the base of the 2nd metacarpal involving the extensor carpi radialis longus insertion are unusual and poorly understood. There is no consensus as to how these fractures should be treated. We report the case of a 2nd metacarpal base fracture in a professional basketball player that was treated surgically with open reduction and internal fixation using cannulated screws. The management of this case is compared to similar cases in the literature.

Extensor carpi radialis longus avulsion: Presentation, treatment rationale and outcome of an unusual fracture

Avulsion fracture of the base of the second metacarpal is a rare injury due to the stability of the carpometacarpal joints. There are few documented cases in the literature of extensor carpi radialis longus (ECRL) avulsion. The ECRL avulses from the base of the second metacarpal usually as a result of forced wrist hyperflexion and can be exacerbated with the hand in ulnar deviation. This is often as a result of a fall and the patient usually presents with pain in the region of, and dorsal to, the anatomical snuffbox. The base of the second metacarpal articulates with the base of the third metacarpal, capitate, trapezium and trapezoid. The ECRL has its origin on the lower third of the lateral epicondyle and the supracondylar ridge of the humerus and inserts distally into the base of the second metacarpal. The actions of ECRL are wrist radial deviation and wrist extension, the ECRL imparting a greater moment for radial deviation than the extensor carpi radialis brevis, while the opposite relationship is found for wrist extension. This paper presents the case of a patient with this injury, the diagnostic images, subsequent surgical and therapy management and final outcome.

Snapping wrist caused by tenosynovitis of the extensor carpi radialis longus tendon subsequent to subcutaneous muscle rupture in the forearm: case report

We report a rare case of snapping in the dorsal wrist that was caused by extensor carpi radialis longus tenosynovitis occurring after rupture of the muscle in the middle forearm. After resection of the tendon at the wrist, the snapping disappeared.

Management of intra-articular metacarpal base fractures of the second through fifth metacarpals

Intra-articular fractures of the second through fifth metacarpal bases are uncommon injuries but can result in serious morbidity if improperly managed. These injuries usually occur because of forced flexion of the wrist with simultaneous extension of the arm, as occurs with a punch or a fall. As there are few large series of reports for these injuries, there is no consensus in the current literature on the most appropriate treatment for them. Whereas some authors have reported successful results after closed reduction, many recommend open reduction with internal fixation to ensure the integrity of the tendinous insertions of the extensor carpi radialis longus, extensor carpi radialis brevis, and extensor carpi ulnaris. This article reviews the case reports and case series extant in the literature concerning intra-articular fractures of the bases of the second through fifth metacarpals, and it provides important diagnostic and management considerations for these injuries.

Avulsion fracture of the extensor carpi radialis longus in a rugby player: a case report

Avulsion fracture of the base of the second metacarpal is an unusual injury, and the cause in the few cases reported in the literature was a fall on a volarly flexed wrist. A case of this rare injury suffered in a sport related accident by a semiprofessional rugby player is reported. It was treated with open reduction and internal fixation after failure of conservative management.