Acute Extensor Pollicis Longus Tendon Injury Associated with a Distal Radius Fracture: A Case Report

Overview

Journal Am J Case Rep

Date 2025 Jan 27

PMID 39865643

Authors

Kenjiro Kawamura

Kiyohito Naito

Yasuhiro Yamamoto

So Kawakita

Takamaru Suzuki

Norizumi Imazu

Muneaki Ishijima

Affiliations

Soon will be listed here.

Abstract

BACKGROUND Extensor pollicis longus (EPL) tendon rupture is a potential complication following distal radius fracture, typically occurring several weeks after injury. Herein, we present a rare case of acute extensor pollicis longus tendon rupture associated with a distal radius fracture. CASE REPORT A 35-year-old woman visited our hospital with a distal radius fracture. At the time of examination, the thumb could be moved, although there was pain in the wrist. Computed tomography (CT) revealed a fracture line extending to the ulnar side of Lister's tubercle. During volar locking plate fixation, visual confirmation of the EPL tendon injury was conducted. According to the intraoperative finding, the EPL tendon was 70% ruptured and elongated, and the extension mechanism of the thumb was disrupted. Based on these findings, direct suture of the EPL tendon, including elongation of the ruptured tendon, was performed. One year after surgery, the EPL tendon excursion was smooth, with no limitations in thumb mobility, and the patient had returned to work. CONCLUSIONS This case highlights the importance of recognizing that EPL tendon injury can occur in conjunction with distal radius fractures. The risk of the EPL tendon injury is particularly high when the fracture line extends to the ulnar side of Lister's tubercle, which serves as the EPL tendon floor. When an EPL tendon injury is suspected based on preoperative examination and fracture type, it is important to obtain adequate informed consent and to prepare for potential EPL tendon reconstruction before surgery.

References

Lister R, Bradford 4th H, Joo A, Carr C, Delancy A, Naram A . Spontaneous Rupture of the Extensor Pollicis Longus Tendon: A Systematic Review. Hand (N Y). 2023; 19(8):1314-1320. PMC: 11536720. DOI: 10.1177/15589447231175513. View

Agir I, Aytekin M, Kucukdurmaz F, Gokhan S, Cavus U . Anatomical Localization of Lister's Tubercle and its Clinical and Surgical Importance. Open Orthop J. 2014; 8:74-7. PMC: 4023390. DOI: 10.2174/1874325001408010074. View

Maschke S, Evans P, Schub D, Drake R, Lawton J . Radiographic evaluation of dorsal screw penetration after volar fixed-angle plating of the distal radius: a cadaveric study. Hand (N Y). 2008; 2(3):144-50. PMC: 2527147. DOI: 10.1007/s11552-007-9038-2. View

Naito K, Sugiyama Y, Dilokhuttakarn T, Kinoshita M, Goto K, Aritomi K . A survey of extensor pollicis longus tendon injury at the time of distal radius fractures. Injury. 2017; 48(4):925-929. DOI: 10.1016/j.injury.2017.02.033. View

Kizilay Y, Turan K . Acute bilateral extensor pollicis longus tendon rupture following bilateral displaced distal radius fracture: A case report. Acta Orthop Traumatol Turc. 2023; 57(1):46-49. PMC: 10151867. DOI: 10.5152/j.aott.2023.22105. View

Turner R, Faber K, Athwal G . Complications of distal radius fractures. Orthop Clin North Am. 2007; 38(2):217-28, vi. DOI: 10.1016/j.ocl.2007.02.002. View

Seigerman D, Lutsky K, Fletcher D, Katt B, Kwok M, Mazur D . Complications in the Management of Distal Radius Fractures: How Do We Avoid them?. Curr Rev Musculoskelet Med. 2019; 12(2):204-212. PMC: 6542871. DOI: 10.1007/s12178-019-09544-8. View

Lobo-Escolar L, Lopez Moreno I, Montoya M, Bosch-Aguila M . Functional Recovery Following an L-Lengthening Local Tendon Flap for Extensor Pollicis Longus Chronic Ruptures. J Hand Surg Am. 2017; 42(1):e41-e47. DOI: 10.1016/j.jhsa.2016.11.012. View

Naito K, Zemirline A, Sugiyama Y, Obata H, Liverneaux P, Kaneko K . Possibility of Fixation of a Distal Radius Fracture With a Volar Locking Plate Through a 10 mm Approach. Tech Hand Up Extrem Surg. 2016; 20(2):71-6. DOI: 10.1097/BTH.0000000000000118. View

10.

Roth K, Blazar P, Earp B, Han R, Leung A . Incidence of extensor pollicis longus tendon rupture after nondisplaced distal radius fractures. J Hand Surg Am. 2012; 37(5):942-7. DOI: 10.1016/j.jhsa.2012.02.006. View

11.

Bickert B, Kremer T, Kneser U . [Secondary tendon reconstruction on the thumb]. Unfallchirurg. 2016; 119(12):986-992. DOI: 10.1007/s00113-016-0248-3. View

12.

McKay S, MacDermid J, Roth J, Richards R . Assessment of complications of distal radius fractures and development of a complication checklist. J Hand Surg Am. 2001; 26(5):916-22. DOI: 10.1053/jhsu.2001.26662. View

13.

El Shewy M, El Barbary H, Abdel-Ghani H . Repair of chronic rupture of the achilles tendon using 2 intratendinous flaps from the proximal gastrocnemius-soleus complex. Am J Sports Med. 2009; 37(8):1570-7. DOI: 10.1177/0363546509333009. View

14.

Bullon A, Bravo E, Zarbahsh S, Barco R . Reconstruction after chronic extensor pollicis longus ruptures: a new technique. Clin Orthop Relat Res. 2007; 462:93-8. DOI: 10.1097/BLO.0b013e31806db4b6. View