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

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.