Ahmet DUYMAZ, FURKAN EROL KARABEKMEZ, Mustafa KESKİN, Zekeriya TOSUN

Ekstensör pollisis longus tendon spontan kopmalarının iki olgu ışığında gözden geçirilmesi

Amaç: Spontan ekstensör pollisis longus (EPL) kopması olan iki olguda ekstensör indisis proprius (EIP) tendonun EPL’a transferinin sonuçlarını değerlendirmek ve bu iki olgunun muhtemel etiyolojik faktörlerini tartışmak. Olgu sunumları: Ekmek fırınında işçi olarak çalışan ve pnömotik kompresör operatörü olan iki hastaya EPL’a EIP tendon transferi yapıldı. Eller; bilek 45 derece ekstansiyonda, başparmak metkarpofalengeal (MF) eklemi tam ekstansiyonda, diğer parmak MF eklemleri 60–70 derece fleksiyonda, başparmak interfalengeal eklemi 10–15 derece fleksiyonda olacak tarzda 4 hafta immobilize edildi. Daha sonra her iki hastaya aynı rehabilitasyon programı uygulandı. Değerlendirme ameliyat sonrası parmak hareket açıklığı ile yapıldı. Bulgular: Her iki hastanın iki yıllık takiplerindeki sonuçları mükemmeldi. Sonuç: Spontan EPL tendon kopmasının mekanizmasını açıklamak için birçok etiyoloji ileri sürülse de kesin neden hala bilinmemektedir. Ancak olgularımızdaki gibi bazı meslekler predispozan faktör olabilirler. Spontan EPL kopmasında başparmak ekstansiyonunu sağlamak için en uygun rekonstrüksiyon seçeneği EIP tendon transferidir. Tendon transferi sırasında en uygun gerginliği sağlayacak pozisyon; başparmağın tam ekstansiyon, bileğin nötraldeki pozisyonudur.

Review of spontaneous rupture of extensor pollicis longus tendon in the light of two cases

Objective: To evaluate the outcomes of extensor indicis proprius (EIP) to extensor pollicis longus (EPL) transfers in two cases with spontaneous rupture of the EPL and to discuss possibility of etiological factors of them. Case reports: Two patients, a baker and pneumatic compressor operator, underwent transfer of EIP to EPL. The hands were immobilized with wrist extended 45 degrees, the metacarpophalangeal joint of the thumb was full extended, the other metacarpophalangeal joints were 60-70 degrees flexed, and the interphalangeal joint of the thumb was flexed 10-15 degrees for 4 weeks. Afterwards, the same rehabilitation programs were applied to two cases. Evaluation included postoperative range of motion test. Results: In two years follow up periods; both patients’ functional outcomes were perfect. Conclusion: Although various etiologies have been proposed to explain the mechanism of spontaneous rupture of the EPL, it is not still exactly known. But there may be predisposed factors at some occupations such as our two cases. The most suitable choice for reconstruction of spontaneous rupture of the EPL to restore thumb extension is to transfer the EIP tendon. During the transferring the tendon, the best tensioning position is the fully extended thumb with wrist in neutral position.

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