Extensor indicis proprius to extensor pollicis longus transfer in spontaneous rupture of extensor pollicis longus following non displaced fracture distal end radius

Abstract

Exact incidence of extensor pollicis longus (EPL) ruptures following distal radius fracture is not known. Peculiarly it’s common in nondisplaced fracture of the distal radius with an incidence of EPL rupture of 0.2-5%. Cortical irregularities from distal radius fractures or osteophytes easily abrade the tendon, causing gradual attrition and ultimately rupture. Compromised blood supply is also related to EPL rupture which is supported by microcirculatory anatomic studies. We present a case of 49 year old female who presented with spontaneous rupture of the EPL following a nondisplaced fracture of the distal radius managed by extensor indicis proprius (EIP) transfer. EIP transfer gives promising outcome. Optimum tension of the tendon is crucial for good functional outcome. We recommend suturing the tendon with thumb in extension and wrist in neutral position for optimum tension of tendon to avoid extensor lag and to prevent loss of IP flexion.