J Korean Fract Soc.  2012 Jan;25(1):52-57. 10.12671/jkfs.2012.25.1.52.

Extensor Pollicis Longus Rupture after Distal Radius Fracture

• Cho NY
• Seo CY
• Kim MS
• Kim HS
• Lee KB

• KMID: 1434111
• DOI: http://doi.org/10.12671/jkfs.2012.25.1.52

Abstract

PURPOSE
To evaluate the cause and surgical outcome of extensor pollicis longus rupture after distal radius fractures.
MATERIALS AND METHODS
Nineteen cases in which the patients underwent surgical treatment for rupture of the extensor pollicis longus after distal radius fractures were followed for more than one year. Among the nineteen cases, fourteen extensor pollicis longus ruptures occurred after conservative treatment, four occurred after closed reduction with K-wire fixation, and one occurred after open reduction and internal fixation with a plate. All cases were treated by extensor indicis proprius transfer.
RESULTS
Extensor pollicis longus ruptures were caused by K-wire irritation in two, by a protruding screw tip in one, and by a callus in one. In the conservative treatment group, tendon ruptures were diagnosed at an average of 3.1 months (0.7~17). Tendon ruptures were detected in the surgical treatment group at an average of 12.8 months (1~48). All the patients showed favorable recovery of the extension capability of the thumb at the final follow-up.
CONCLUSION
The main cause of extensor pollicis longus rupture after distal radius fracture was ischemic damage. Therefore, during the surgery, the length and direction of screws and K-wires should be fixed carefully to avoid such damage. Distal radius fracture also requires careful observation of the extensor pollicis longus during follow-up. Furthermore, extensor indicis proprius transfer is considered to be an effective method for extensor pollicis longus rupture.

Keyword

Distal radius fracture; Extensor pollicis longus rupture

MeSH Terms

Bony Callus
Follow-Up Studies
Humans
Radius
Radius Fractures
Rupture
Tendons
Thumb

Figure

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  Fig. 1 (A, B) Plain radiographs in 78 year-old female patient showed successful union with multiple K-wires fixation at 3 months after distal radius fracture surgery. (C, D) Extensor pollicis longus (white arrow) was mechanically irritated by K-wire (black arrow).

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  Fig. 2 (A, B) Plain radiographs in 51 year-old female patient showed successful union with volar locking plate at 2 months after distal radius fracture surgery. (C) Extensor pollicis longus was mechanically irritated by protruded screw tip (black arrow).

Reference

1. Berglund LM, Messer TM. Complications of volar plate fixation for managing distal radius fractures. J Am Acad Orthop Surg. 2009. 17:369–377.

2. Blakeney WG. Stabilization and treatment of Colles fractures in elderly patients. Clin Interv Aging. 2010. 5:337–344.

3. Christophe K. Rupture of the extensor pollicis longus tendon following colles fracture. J Bone Joint Surg Am. 1953. 35:1003–1005.

4. De Smet L, Van Loon J, Fabry G. Extensor indicis proprius to extensor pollicis longus transfer: results and complications. Acta Orthop Belg. 1997. 63:178–181.

5. Duplay S. Rupture sous-cutan e du tendon du entenseur du pouce de la main droite, au niveau de la tabaiti re anatomique. Flexion permanente du pouce. R tablissement de la facult d'extension par une opration (suture de l'extr mit du tendon rompu avec le premier radial externe). Bullet M m Soc Chir de Paris. 1876. 2:788–791. (cited from Kenneth Christophe : Rupture of the extensor pollicis longus tendon following Colls'fracture. J Bone Joint Surg Am, 35: 1003-1005, 1953).

6. Goldner JL. Tendon transfers in rheumatoid arthritis. Orthop Clin North Am. 1974. 5:425–444.

7. Hamlin C, Littler JW. Restoration of the extensor pollicis longus tendon by an intercalated graft. J Bone Joint Surg Am. 1977. 59:412–414.

8. Helal B, Chen SC, Iwegbu G. Rupture of the extensor pollicis longus tendon in undisplaced Colles' type of fracture. Hand. 1982. 14:41–47.

9. Hirasawa Y, Katsumi Y, Akiyoshi T, Tamai K, Tokioka T. Clinical and microangiographic studies on rupture of the E.P.L. tendon after distal radial fractures. J Hand Surg Br. 1990. 15:51–57.

10. Kwedar AT, Mitchell CL. Late rupture of extensor pollicis longus tendon following Colles' fracture. J Bone Joint Surg Am. 1940. 22:429–435.

11. Magnell TD, Pochron MD, Condit DP. The intercalated tendon graft for treatment of extensor pollicis longus tendon rupture. J Hand Surg Am. 1988. 13:105–109.

12. Magnussen PA, Harvey FJ, Tonkin MA. Extensor indicis proprius transfer for rupture of the extensor pollicis longus tendon. J Bone Joint Surg Br. 1990. 72:881–883.

13. Mannerfelt L, Oetker R, Ostlund B, Elbert B. Rupture of the extensor pollicis longus tendon after Colles fracture and by rheumatoid arthritis. J Hand Surg Br. 1990. 15:49–50.

14. McMaster PE. Late ruptures of extensor and flexor pollicis longus tendons following colles' fracture. J Bone Joint Surg Am. 1932. 14:93–101.

15. Noordanus RP, Pot JH, Jacobs PB, Stevens K. Delayed rupture of the extensor pollicis longus tendon: a retrospective study. Arch Orthop Trauma Surg. 1994. 113:164–166.

16. Park JW. Operative treatment of distal radius fracture. J Korean Fract Soc. 2006. 19:497–503.

17. Pulvertaft RG. Tendon grafts for flexor tendon injuries in the fingers and thumb; a study of technique and results. J Bone Joint Surg Br. 1956. 38:175–194.

18. Riddell DM. Spontaneous rupture of extensor pollicis longus: The result of tendon transfer. J Bone Joint Surg Br. 1963. 45:506–510.

19. Skoff HD. Postfracture extensor pollicis longus tenosynovitis and tendon rupture: a scientific study and personal series. Am J Orthop (Belle Mead NJ). 2003. 32:245–247.

20. Taras JS, Ladd AL, Kalainov DM, Ruch DS, Ring DC. New concepts in the treatment of distal radius fractures. . Instr Course Lect. 2010. 59:313–332.

21. Trevor D. Rupture of the extensor pollicis longus tendon after colles fracture. J Bone Joint Surg Br. 1950. 32:370–375.

22. Yim SJ, Jeong YC, Yoon SR, Choi JG, Suh YS, Rah SK. Delayed rupture of the extensor pollicis longus due to Fracture of the distal radius: a case report. J Korean Soc Fract. 1999. 12:162–165.