Anterior interosseous nerve palsy mimicking rupture of the index flexor digitorum profundus after volar locking plate fixation of a distal radius fracture

We describe the case of a patient with distal radius fracture who became unable to flex the distal interphalangeal joint of the index finger after internal fixation using a volar locking plate. There was palpable crepitus with active thumb motion, and wrist radiographs showed prominence of the volar...

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Bibliographic Details
Published in:Nagoya journal of medical science 2017-08, Vol.79 (3), p.421-425
Main Authors: Shinohara, Takaaki, Takahashi, Sayako, Hirata, Hitoshi
Format: Article
Language:English
Subjects:
Adult
Bone Plates
Case Report
Fracture Fixation, Internal
Humans
Male
Radius Fractures - diagnostic imaging
Radius Fractures - physiopathology
Radius Fractures - surgery
Range of Motion, Articular
Tendon Injuries - diagnostic imaging
Tendon Injuries - physiopathology
Tendon Injuries - surgery
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Summary:We describe the case of a patient with distal radius fracture who became unable to flex the distal interphalangeal joint of the index finger after internal fixation using a volar locking plate. There was palpable crepitus with active thumb motion, and wrist radiographs showed prominence of the volar plate at the watershed line. Therefore, our initial diagnosis was plate-induced closed rupture of the flexor digitorum profundus tendon of the index finger. However, upon surgical removal of the plate, no tendon rupture was found. Magnetic resonance imaging after plate removal showed diffuse increased signal intensity in the index flexor digitorum profundus on T2-weighted fat-suppressed images, which indicated muscle denervation. Based on the above findings, we changed the diagnosis to anterior interosseous nerve palsy with isolated paralysis of the flexor digitorum profundus of the index finger. Finger flexion disability following volar plate fixation of distal radius fracture should always be investigated carefully..
ISSN:0027-7622
2186-3326
DOI:10.18999/nagjms.79.3.421