First dorsal compartment musculotendinous avulsion accompanied by close radial styloid fracture: Case report

Highlights • Our study is the third case report about radial styloid fracture accompanying with first extensor compartment muscles rupture. • Our study will be the first study in this issue because of some privileges. • Other case report did not have long term follow-up time, mean that just 8 month follow-up time. • Our study also has preoperative MRI views and intraoperative photographs. • First case report; which was about this issue, muscle strength test was not applied by authors.
Introduction Radial styloid fracture and concomitant first dorsal compartment proximal musculotendinous avulsion is extremely rare injury. This togetherness is difficult to diagnose fully on routine physical examination. Presentation of case In this study, we present a thirty nine year old male patient who suffered musculotendinous avulsion injury of the extensor pollicis brevis (EPB) tendon and abduc- tor pollicis longus (APL) tendon that is rarely accompanied by a closed, non-displaced radial styloid fracture developed following an in-car traffic accident. Diagnosis of avulsion was made with preop- erative magnetic resonance imaging (MRI) and the fracture was fixed with open reduction. The measurements of isometric APL and EPL muscle strength for two thumb were performed using a digital hand dynamometer, no statistically significant difference was found between the muscle strengths of the affected and non-affected thumbs at the postoperative second year follow- up (p > 0.05). Discussion The literature does not hold enough cases to establish the grounds for hypotheses related to the injury mechanism in the 1 st extensor tendon musculotendinous injuries ac- companying radial styloid fractures. Although the diagnosis of the injury in our case was inadver- tently made with preoperative MRI, the routine application of MRI does not seem to be cost-effec- tive. Conclusion We suggest that checking and assuring the intactness of the 1 st extensor compartment with a gentle traction during surgery should be a routine step in the treatment of radial styloid fractures treated with open reduction.