Excessive Thumb Motion Causing Delayed Tendon Injury to Wrist First Extensor Compartment Associated with Flexible Nail

Abstract

Aim: To withdraw the attention to the possible complication of tendons rupture in cases of intramedullary flexible nail fixating cases of pediatric both bone forearm fractures. Presentation of Case: A 16 years old boy with a history of right forearm both bones mid shaft fracture was managed with closed reduction and flexible intra-medullary nail fixation. The patient was doing fine but, four months later he sustained sharp pain that was associated with limitation of thumb motions while using a video game controller. Surgical exploration revealed rupture of Extensor Polices Brevis (EPB) and attrition of Abductor Pollicis Longus (APL) tendons by rubbing over the free bent end of the flexible nail. This complication was managed satisfactorily. Discussion: The authors are reporting this case for the treating physicians to be aware about such complication, which should be avoided. Elaborating for the first time a presumed causal association between daily thumb motion and risk of injury that should be kept in mind while treating such cases to prevent possible complication. Conclusion: Treating mid-shaft radial fracture in children with flexible nails is subjected to this possible complication. The free end of the flexible nail must be away from the excursion of any of wrist tendons. Changes in lifestyle habits that result in excessive motion of the involved joint should be avoided. A multidisciplinary team approach is essential in the management plan.