Osseous extensor tendon rupture

What is the therapy approach to an osseous extensor tendon rupture?

An osseous extensor tendon rupture – also referred to as Busch fracture – in many cases can be treated conservatively with the help of a stax finger splint.

The image shows an osseous extensor tendon rupture (so-called Busch fracture). The immobilization in this case is provided through a stax finger splint.

Even if the fracture is slightly dislocated, the end result of such immobilization is usually fairly positive.

When is surgery necessary?

A conservative therapy approach typically is selected for all smaller bone fragments which became detached along with the ruptured extensor tendon. Even for slightly larger bone fragments a conservative therapy could be appropriate as long as the bone fragments can adequately be positioned within the splint. And last but not least, mildly dislocated joint surfaces after six months to one year often recover so beautifully, that the patient is in the position to use his/her distal interphalangeal joint without noticing any functional deficits.

In which cases is surgery recommended?

The larger the disconnected bone fragment, or the severer the dislocation of the bone fragment is, the more surgery provides a beneficial therapy approach. It should however, be emphasized that in only very few cases surgery has proven to be the better therapy choice.

How is surgery on an osseous extensor tendon rupture carried out?

The image shows an extensor tendon rupture to the thumb distal interphalangeal joint after surgery.

The fracture was beautifully mended and is basically nearly invisible.

This procedure involves the re-establishment of the bone fragment in the precise location where it belongs. The stabilization may be achieved through different methods. Some surgeons stabilize the bone fragment with the help of a wire while applying an additional rigid wire through the joint. Other physicians select a small titanium screw to achieve stabilization as this approach allows for solid fixation of the bone fragment as well (see image above).

Is it necessary to remove the screw at a later time?

Screws only need removing if they become bothersome to the patient!

Wires, however, always need to be removed as they obstruct the joints. Even if a wire only serves to fixate a bone fragment, in younger people there is a considerable danger that the wire will loosen and pierce through the skin. If this is not treated appropriately – for example because it happens while traveling on vacation, the risk for an infection is fairly high. This is why such a Kirschner wire (K-wire) should be surgically removed once the healing process has been assessed and deemed completed (can easily be visualized through an x-ray image).

Which method of anesthesia should be applied for surgery on an osseous extensor tendon rupture?

A simple digital block will not suffice for this type of surgery as the amount of time needed to perform the procedure would cause great pain to an arm that is being kept bloodless.

A very proven method of anesthesia for this type of surgery is to numb the entire arm. Well-established is the brachial plexus block which requires the numbing of the nerve network located underneath the shoulder.

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