gms | German Medical Science

Objectives/Interrogation: The aim of this work is to determine/evaluate the functional outcome of an extensor indicis proprius (EIP) tendon transposition after an extensor pollicis longus (EPL) chronic rupture based on a clinical case.

Methods: The autors report a case of an individual, female, 50 years old, factory worker, that had an EPL chronic rupture on the TV zone with nearby 6 months and complete lost of the thumb extension.

The surgery performed was a transposition of the ipsilateral EIP tendon and the tenodesis was done using the pulvertaft technique. Study-specific outcome measures were used to assess function in activities of daily living, pain, and patient satisfaction: grip strength, pinch strength, range of motion, kapandji score and DASH score. The current follow-up was 5 months.

Results and Conclusions: The patient maintained a cast immobilization during the first four weeks of surgery and then it was changed to an orthosis and the patient started to do physiotherapy.

After 15 weeks of surgery the kapandji score was 10. After 20 weeks of surgery the kapandji score was still 10, the pinch strength was 2,5 kg (5 kg on the contralateral side), the grip strength was 18 kg (22 kg on the contralateral side), the range of motion was 90º (100º on the contralateral side) and the Quick DASH score of 11,4.

Besides the EIP tendon has been the used tendon on the case reported, the extensor digitorum profundus communis II is also a valid option and the pulvertaft technique was used because of the unequal size of the tendons.

The authors concluded that the transposition of the EIP for the EPL chronic rupture is a safe and effective procedure, with good functional outcomes. The success of this surgery depends on a rigorous technique and an appropriate program of functional rehabilitation so that further clinical and biomechanical investigations may give additional informations about the postoperative management, in order to maximize the surgical outcomes.