Clin Orthop Surg.  2012 Dec;4(4):325-328. 10.4055/cios.2012.4.4.325.

Delayed Rupture of Flexor Pollicis Longus after Volar Plating for a Distal Radius Fracture

• Cho CH
• Lee KJ
• Song KS
• Bae KC

• KMID: 1719302
• DOI: http://doi.org/10.4055/cios.2012.4.4.325

Abstract

Although extensor tendon rupture often occurs after volar plating for a distal radius fracture, a flexor tendon rupture is extremely rare. Most reported instances of flexor tendon ruptures after volar plating have involved improper placement of the plate, increased prominence of the distal edge of the plate because of collapse of the fracture site, use of custom-made plates, current steroid use by the patient, or a history of tendon injury. We report a case of delayed rupture of the flexor pollicis longus tendon 40 months after volar plating with a 3.5-mm T-locking compression plate for which the distal edge was located at the transverse ridge level of the distal radius. If symptoms such as tendon irritation occur in this situation, surgeons should consider removing the plate as soon as possible after bony union is achieved.

Keyword

Flexor pollicis longus; Distal radius fracture; Volar plating; Delayed rupture

MeSH Terms

*Bone Plates
Female
Fracture Fixation, Internal/*methods
Humans
Middle Aged
Radius Fractures/*complications/pathology/*surgery
Rupture
Tendon Injuries/*etiology/*surgery
Thumb/physiopathology

Figure

• 

  Fig. 1 Initial anteroposterior (A) and lateral (B) plain radiographs show the intra-articular comminuted distal radius fracture with dorsal displacement.

• 

  Fig. 2 Anteroposterior (A) and lateral (B) plain radiographs obtained at 40 months after surgery show no interval change in comparison with radiographs obtained immediately after surgery.

• 

  Fig. 3 Intraoperative findings show a total rupture of the flexor pollicis longus tendon with granulation and fraying of tissue in the ruptured margin.

Reference

1. Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate. J Orthop Trauma. 2007. 21(5):316–322.

2. Louis DS. Prospective multi-center trial of a plate for dorsal fixation of distal radius fractures. J Hand Surg Am. 1998. 23(2):353–354.

3. Schnur DP, Chang B. Extensor tendon rupture after internal fixation of a distal radius fracture using a dorsally placed AO/ASIF titanium pi plate: Arbeitsgemeinschaft fur Osteosynthesefragen/Association for the Study of Internal Fixation. Ann Plast Surg. 2000. 44(5):564–566.

4. Bell JS, Wollstein R, Citron ND. Rupture of flexor pollicis longus tendon: a complication of volar plating of the distal radius. J Bone Joint Surg Br. 1998. 80(2):225–226.

5. Cross AW, Schmidt CC. Flexor tendon injuries following locked volar plating of distal radius fractures. J Hand Surg Am. 2008. 33(2):164–167.

6. Duncan SF, Weiland AJ. Delayed rupture of the flexor pollicis longus tendon after routine volar placement of a T-plate on the distal radius. Am J Orthop (Belle Mead NJ). 2007. 36(12):669–670.

7. Klug RA, Press CM, Gonzalez MH. Rupture of the flexor pollicis longus tendon after volar fixed-angle plating of a distal radius fracture: a case report. J Hand Surg Am. 2007. 32(7):984–988.

8. Nunley JA, Rowan PR. Delayed rupture of the flexor pollicis longus tendon after inappropriate placement of the pi plate on the volar surface of the distal radius. J Hand Surg Am. 1999. 24(6):1279–1280.

9. Koo SC, Ho ST. Delayed rupture of flexor pollicis longus tendon after volar plating of the distal radius. Hand Surg. 2006. 11(1-2):67–70.

10. Orbay JL, Touhami A. Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop Relat Res. 2006. 445:58–67.