J Korean Soc Surg Hand.  2017 Sep;22(3):202-207. 10.12790/jkssh.2017.22.3.202.

Extensor Pollicis Longus Tendon Rupture with Concomitant Rupture of the Extensor Digitorum Communis II Tendon and Extensor Indicis Proprius after Volar Plating for Distal Radius Fracture

• Kim HJ
• Lee HJ
• Kim DH
• Kim JW
• Oh JW

• KMID: 2391218
• DOI: http://doi.org/10.12790/jkssh.2017.22.3.202

Abstract

Extensor tendon rupture is well known complication following distal radius fracture after either conservative treatment or volar plating. However, there are not many reports in literature about concomitant ruptures of other extensor tendons. We report a case of delayed rupture of extensor pollicis longus (EPL), second extensor digitorum communis (EDC II), and extensor indicis proprius (EIP) tendons 4 weeks after volar plating for distal radius fracture. Due to the absence of EIP, EIP transfer was discouraged for EPL reconstruction. Thumb and index finger extension was restored by palmaris longus tendon graft for EPL and EDC II.

Keyword

Distal radius fracture; Volar plating; Extensor pollicis longus; Extensor digitorum communis II; Extensor indicis proprius; Tendon rupture

MeSH Terms

Fingers
Radius Fractures*
Radius*
Rupture*
Tendons*
Thumb
Transplants

Figure

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  Fig. 1. Axial and three-dimensional computed tomography images demonstrating a fracture of Lister’s tubercle on the right side (arrows). A bony spur created a the gap between the fragment and the main radius part and might be the cause for tear of the tendon.

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  Fig. 2. Preoperative and postoperative plain radiography showed that the fracture gap of the Lister’s tubercle persisted.

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  Fig. 3. In the physical examination, limitations in thumb interphalangeal and index metacarpophalangeal joint extensions were observed when compared with those on the normal side.

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  Fig. 4. Axial image of ultrasonography showed complete disruptions of the extensor pollicis longus, (solid arrow) and fracture gap of Lister’s tubercle (vacant arrow).

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  Fig. 5. The ruptures of the extensor pollicis longus (arrowhead), extensor indicis proprius (solid arrow), and extensor digitorum communis II (vacant arrow). The asterisk shows a bony spur near Lister’s tubercle.

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  Fig. 6. After removing the bony protrusion, the surrounding soft tissue was pulled to the ulnar side and sutured to the remaining tendon sheath and periosteum of the 3rd compartment to prevent further tendon tear (solid arrow).

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  Fig. 7. EPL (solid arrow), and EDC II (vacant arrow) were reconstructed with the PL tendons using the Pulvertaft technique. EPL, extensor pollicis longus; EDC II, extensor digitorum communis; PL, palmaris longus.

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  Fig. 8. After 10 months, the interphalangeal joint of the thumb and the metacarpophalangeal joint of the index finger showed a persistent 20° of extension lag (the flexion photograph was not taken).

Reference

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