Flexor pollicis longus tendon rupture by sandwiched underlying volar locking plate and distal radius

Abstract

Flexor pollicis longus (FPL) tendon rupture is a major complication of volar locking plate fixation for distal radius fractures. The tendon rupture is usually caused by friction between the distal edge of the plate and the FPL tendon, and has been well detected recently with ultrasonography. Rarely, the volar locking plate itself entraps the FPL tendon, leading to its rupture. A 63-year-old man was consistently unable to flex his right thumb after previous surgery for a distal radius fracture at another hospital. Ultrasonography demonstrated loss of tendon gliding and unusual patterns of the FPL tendon. The tendon was sandwiched between the plate and the distal radius, and was penetrated by the distal locking screw, which was comparable to intraoperative findings of complete entrapment and rupture of the FPL tendon from the underlying plate. The tendon defects were repaired using a palmaris longus tendon graft after removing the screws and plate. Finally, he could flex his thumb actively with satisfaction. Unusual patterns of FPL tendon rupture buried under inadequate plate positioning must be recognized, as in this case. Ultrasonographic assessment is routinely recommended to visibly determine any FPL tendon damage after volar locking plate fixation for distal radius fractures.

Influence of the flexor digitorum superficialis tendon transfer on grip strength

“…An FDS-IV transfer can also be used to restore opposition of the thumb in case of distal median nerve palsy or to restore finger and thumb extension in case of a radial nerve palsy (Boyes transfer) (Skie et al, 2010). Up to 12% of patients receiving a volar plate osteosynthesis for treatment of a distal radius fracture experience a rupture of the flexor pollicis longus (FPL) tendon (Drobetz and Kutscha-Lissberg, 2003;Uemura et al, 2018). Chronic FPL insufficiency can also result if a tendon injury is missed or if tendon repair has failed.…”

Rupture of the Flexor Pollicis Longus Tendon Involved between the Radial Shaft and the Volar Locking Plate

“…3,4 In one report, partially ruptured FPL tendon (around 40%) was primarily repaired during exploration 9 days after the first operation, 3 whereas totally ruptured FPL tendon was reconstructed by PL tendon grafting in the other report. 4 The most characteristic involvement of the FPL tendon between the plate and radial shaft is that the thumb motion is restricted immediately after surgery. Surgeons should be aware of this condition when the thumb motion was limited immediately after the surgery.…”

Radiocarpal joint stiffness following surgical treatment for distal radius fractures: the incidence and associated factors

“…However, even with surgical treatment, radiocarpal joint stiffness (RJS) is a common postoperative complication following DRFs, which greatly influence patients' normal function [11,12]. Previous studies have investigated many postoperative complications following DRFs, such as tendon spontaneous rupture [13,14], loss of reduction [15,16], injury of triangular fibrocartilage complex [17], or wrist pain [18,19]. To the best of our knowledge, no studies have been reported about postoperative RJS.…”