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

Hee-June Kim; Hyun-Joo Lee; Dong-Hyun Kim; Joon-Woo Kim; Ji Won Oh

doi:10.12790/jkssh.2017.22.3.202

Journal List > J Korean Soc Surg Hand > v.22(3) > 1106573

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Kim, Lee, Kim, Kim, and Oh: 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

Original Article

J Korean Soc Surg Hand 2017;22(3):202-207.

Published online: 11 September 2017

DOI: https://doi.org/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

Hee-June Kim¹, Hyun-Joo Lee¹, Dong-Hyun Kim¹, Joon-Woo Kim¹, Ji Won Oh²

¹Department of Orthopaedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea

²Department of Anatomy, Kyungpook National University School of Medicine, Daegu, Korea

Correspondence to: Hyun-Joo Lee Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 130 Dongduk-ro, Jung-gu, Daegu 41944, Korea TEL: +82-53-200-5628 FAX: +82-53-422-6605 E-mail: hjleeleehj@gmail.com

Received 9 April 201710 July 2017 Accepted 19 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Distal radius fracture, Volar plating, Extensor pollicis longus, Extensor digitorum communis II, Extensor indicis proprius, Tendon rupture

References

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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.

Fig. 2.

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

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.

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).

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.

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).

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.

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).

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