gms | German Medical Science

Introduction: The first finger is fundamental for the correct operation of the hand, allows one of the main functions that is the realization of clamp. Extensor Pollicis Longus tendon rupture can be spontaneous, traumatic, secondary to rheumatoid arthritis, secondary to the use of corticosteroids or as a sequela of friction with a screw of a volar plate used for the treatment of fractures of distal radius. The direct sutures of the injured ends of the Extensor Pollicis Longus under the extensor retinaculum have a high failure rate. Transposition of the Extensor Indicis is a surgical technique to be considered for the repair of this type of injuries.

The objective of this work is to demonstrate the surgical technique that we use after a rupture of the EPL tendon by friction of screws placed in a DVR plate with favorable functional results

Methods: A 42-year-old female patient who, after falling from her own height with a left wrist in extension, presented a fracture of the distal radius Fernández III, AO 2R3A2.2. Surgical treatment, open reduction plus internal fixation with a volar plate for distal radius (DVR) is performed. Two years after the surgery the patient presented an inability to extend the distal phalanx of the thumb, with apparent loss of strength, which is why an ultrasound study was performed that reported empty space in the third extensor compartment, absence of Extensor Pollicis Longus tendon, in addition to surgical material (screw), that crosses the dorsal cortex and is evidenced in the third compartment.

The tendon ends are located at 2.3 cm. Tendinous transfer of the Extensor Indicis tendon to the Extensor Pollicis Longus tendon is performed, with adequate functional recovery.

Surgical Technique: Identification of the Extensor Indicis tendon at the level of the wrist and distal tenotomy at the metacarpophalangeal level. The extraction of the Extensor Indicis tendon and the distal end of the Extensor Pollicis Longus is performed, both ends are faced, and a terminal term repair is carried out using the pulvertaft technique

Results and Conclusions: The rupture of the Extensor Pollicis Longus secondary to friction by a volar plate screw of distal radius is a rare complication, however, it causes serious functional limitations. Direct repairs of injured extremities, under the extensor retinaculum, are associated with a high failure rate, so the transfer of the Extensor Indicis to the Extensor Pollicis Longus is a relatively simple technique to perform, with good functional results.