Comparison of Palmaris Longus Tendon Graft and Extensor Indicis Proprius Tendon Transfer for Reconstruction of the Extensor Pollicis Longus Tendon

Jun-Mo Lee; Myung Jae Hyun; Kyu Bum Seo

doi:10.12790/ahm.2017.22.4.224

Journal List > Arch Hand Microsurg > v.22(4) > 1106598

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Lee, Hyun, and Seo: Comparison of Palmaris Longus Tendon Graft and Extensor Indicis Proprius Tendon Transfer for Reconstruction of the Extensor Pollicis Longus Tendon

Original Article

Archives of Hand and Microsurgery 2017; 22(4): 224-232.

Published online: 31 December 2017

DOI: https://doi.org/10.12790/ahm.2017.22.4.224

Comparison of Palmaris Longus Tendon Graft and Extensor Indicis Proprius Tendon Transfer for Reconstruction of the Extensor Pollicis Longus Tendon

Jun-Mo Lee¹, Myung Jae Hyun², Kyu Bum Seo²

¹Department of Orthopedic Surgery, Chonbuk National University Medical School, Jeonju, Korea.

²Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.

Corresponding author: Kyu Bum Seo. Department of Orthopedic Surgery, Jeju National University Hospital, 15 Aran 13-gil, Jeju 63241, Korea. TEL: +82-64-717-1690, FAX: +82-64-717-1131, cbnuoskbs@jejunu.ac.kr

Received 17 April 2017 Revised 19 September 2017 Accepted 21 September 2017

Korean Society for Surgery of the Hand, Korean Society for Microsurgery

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the results of reconstruction of extensor pollicis longus tendon treated by palmaris longus tendon graft and extensor indicis proprius tendon transfer.

Methods

Authors have performed reconstruction of the delayed 27 cases of the ruptured extensor pollicis longus tendon from March 2006 through February 2016 at Jeju National University Hospital with either palmaris longus tendon graft or extensor indicis proprius tendon transfer. Out of 27 patients, 12 patients were treated by palmaris longus tendon graft and 15 patients were treated by extensor indicis proprius tendon transfer. Postoperatively thumbs were immobilized with thumb spica short arm splint in extension and abduction position for 4 weeks. Active and passive exercise of the thumb with extension and abduction was recommended. The functions of the thumbs were assessed by the Riddell's classification and statistically compared.

Results

At average 21.7 months follow-up, 13 cases (48.1%) were excellent, 11 cases (40.7%) were good, and 3 cases (11.1%) were fair according to the functional evaluation of Riddell. No significant differences were noted between two groups except the operation time.

Conclusion

Ruptured extensor pollicis longus tendon could be reconstructed with palmaris longus tendon graft or extensor indicis proprius tendon transfer and final functional outcome could be good in long-term follow-up.

Keywords: Extensor pollicis longus tendon, Palmaris longus tendon graft, Extensor indicis proprius tendon transfer

Figures and Tables

Fig. 1

Tendon transfer with extensor indicis proprius tendon. (A) A photograph shows limited extension of the right thumb caused by ruptured extensor pollicis longus tendon. (B) Proximal and distal end of ruptured extensor pollicis longus tendon is identified. (C) Extensor indicis proprius tendon was obtained. (D) The proximal part of extensor indicis proprius tendon and the distal end of the extensor pollicis longus tendon was sutured with Pulvertaft method with wrist in neutral position and thumb extended. (E) A photograph shows extension and dorsal elevation of right thumb at last follow-up visit.

Fig. 2

Interpositional tendon graft with Palmaris longus tendon. (A) Identification of the proximal and distal end of the ruptured extensor pollicis longus tendon. (B) Palmaris longus tendon was obtained. (C) The free tendon graft with Palmaris longus tendon was done with Pulvertaft method with wrist in neutral position and thumb extended. (D) A photograph shows extension and dorsal elevation of left thumb at last follow-up visit.

Table 1

Comparison of two groups

Values are presented as number only or median (range).

Table 2

Summary of cases

OP: operative, F/U: follow-up, M: male, F: female, Lt: left, Rt: right, Fx.: fracture, PL: palmaris longus tendon, EIP: extensor indicis proprius tendon.

^*Classification of Kleinert and Verdan.

Table 3

Classification of results by Riddell4

Table 4

Comparison of results (p=0.361)

^*Classification of results by Riddell4.

Notes

This work was supported by a research grant from Jeju National University Hospital in 2013.

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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