Rupture of the extensor pollicis longus tendon after wrist trauma

In the period of 1976 to 1997 our clinic treated 33 patients after Colles fracture with ruptured extensor pollicis longus tendon. The occurrence of functional loss was observed after the trauma in 3 to 9 weeks. In 30 cases the surgical treatment of extensor indicis proprius tendon, in 2 cases a direct suture of the ruptured tendon was performed as a primary repair and in one patient a palmaris longus interposition was utilised.     

Rupture of the extensor pollicis longus tendon: a study of aetiological factors

Although rupture of the extensor pollicis longus (EPL) tendon is a wellknown complication of distal radial fractures, a number of patients rupture the EPL because of other conditions. We have retrospectively studied the aetiology of 27 ruptures of the EPL in 26 consecutive patients. Of 19 patients with injured wrists 12 had distal radial fractures, five had blunt trauma, and two had stab wounds that resulted in rupture. In the radial fractures operated on, the EPL rupture was caused by chafing against a dorsal plate (n?=?2) or wear against the pins of an external fixator (n?=?2). Six patients were taking steroids for systemic diseases and in two cases a local steroid injection was given just before the rupture. We conclude that previous injury is the most common cause of rupture of the EPL, but that rheumatoid arthritis or local or systemic steroids, or both, are also important aetiological factors. Seven patients had an iatrogenic cause for their rupture.     

Rupture of the extensor pollicis longus tendon: a study of aetiological factors.

Although rupture of the extensor pollicis longus (EPL) tendon is a well-known complication of distal radial fractures, a number of patients rupture the EPL because of other conditions. We have retrospectively studied the aetiology of 27 ruptures of the EPL in 26 consecutive patients. Of 19 patients with injured wrists 12 had distal radial fractures, five had blunt trauma, and two had stab wounds that resulted in rupture. In the radial fractures operated on, the EPL rupture was caused by chafing against a dorsal plate (n = 2) or wear against the pins of an external fixator (n = 2). Six patients were taking steroids for systemic diseases and in two cases a local steroid injection was given just before the rupture. We conclude that previous injury is the most common cause of rupture of the EPL. but that rheumatoid arthritis or local or systemic steroids, or both, are also important aetiological factors. Seven patients had an iatrogenic cause for their rupture.     

Rupture of the extensor pollicis longus tendon in trapeziometacarpal joint osteoarthritis: case report

We report a case of rupture of the EPL tendon that occurred in a patient with trapeziometacarpal joint osteoarthritis. We assume that the rupture was secondary to attrition caused by a bony protrusion of advanced trapeziometacarpal joint osteoarthritis.     

Rupture of the extensor pollicis longus tendon after Colles fracture and by rheumatoid arthritis

During the period 1973-1986, 116 patients with rupture of the extensor pollicis longus tendon were operated upon. The lesions were categorised into three anatomical levels: proximal, intermediate and distal. Direct suture was performed for acute lesions; later reconstructive procedures were by means of tendon transfers or free tendon grafts.     

Accessory extensor pollicis longus

Phylogenetically the accessory extensor pollicis longus in man seems to find its origin in the deep extensor layer, and this has largely been described in primates. I describe a case and present a comprehensive review of other publications on the subject.     

Rupture of the extensor pollicis longus tendon without fracture after wrist trauma: case reports.

Four cases of rupture of the tendon of the extensor pollicis longus without detectable fracture after wrist injury are reported. The clinical features of this condition did not differ materially from those of rupture occurring after a Colles fracture. All patients were rather young, the average age being 40 years. In one patient rupture occurred a day after injury. In all patients satisfactory thumb function was restored with extensor indicis proprius tendon transfer.     

Effects of extensor pollicis longus transposition and extensor indicis proprius transfer to extensor pollicis longus on thumb mechanics

PURPOSE: The spatial relationship of the extensor pollicis longus (EPL) to the thumb carpometacarpal (CMC) joint may be altered by its transposition from the third dorsal wrist compartment and by subcutaneous extensor indicis proprius (EIP) to EPL tendon transfer. Changes in tendon position could alter thumb function. This study examined changes in the EPL adduction moment arm after EPL tendon transposition from its extensor compartment or EIP transfer. METHODS: The EPL adduction moment arm at the thumb carpometacarpal joint was determined under 4 tendon conditions: (1) intact extensor pollicis longus, (2) transposed extensor pollicis longus, (3) extensor indicis proprius to extensor pollicis longus tendon transfer through an extensor retinacular pulley, and (4) extensor indicis proprius tendon transfer through a subcutaneous route. Each tendon condition was tested in 2 wrist positions: neutral and 40 degrees of flexion. RESULTS: The wrist neutral/flexion moment arms for the 4 tendon conditions, in millimeters, were 9.2/7.3, 3.6/1.2, 8.3/5.1, and 4.8/1.0. CONCLUSIONS: EPL transposition produces a significant decrease of its adduction moment arm at the thumb CMC joint, an effect exacerbated by wrist flexion. The moment arm mechanics of the pulley and subcutaneous EIP tendon transfer resemble those of the intact and transposed EPL, respectively. Diminution of the adduction moment arm could impair thumb function, especially adduction.     

Accessory extensor pollicis longus.

Phylogenetically the accessory extensor pollicis longus in man seems to find its origin in the deep extensor layer, and this has largely been described in primates. I describe a case and present a comprehensive review of other publications on the subject.     

Thumb function without the abductor pollicis longus and extensor pollicis brevis

Two patients are reported in which one thumb has lost the abductor pollicis longus and extensor pollicis brevis tendons. This is an uncommon injury in isolation, and these cases provide an opportunity to assess the functional importance of these musculotendinous units.     

Rupture of the extensor pollicis longus tendon following dorsal entry flexible nailing of radial shaft fractures in children

Introduction

Diaphyseal forearm fractures are common in children and adolescents. Intramedullary fixation with flexible nails has a high success rate. Complications related to the insertion of the radial nail include injury to the superficial branch of the radial nerve and rupture of the extensor pollicis longus (EPL) tendon.

Materials and Methods

We report a series of nine patients who sustained an EPL injury related to the insertion of an elastic intramedullary nail into the radius.

Results

All nine patients underwent operative management, consisting of either EPL release, EPL direct repair, or tendon transfer (using extensor indicis proprius). In all cases, the nail entry site was directly related to the location of EPL. In many of the cases the EPL dysfunction occurred early on but it’s recognition was often delayed.

Conclusion

Based on our findings, we recommend the use of a radial entry point. For surgeons who prefer the dorsal entry point, we recommend that they use an incision which allows visualisation of the extensor tendons and that any post-operative EPL dysfunction is addressed promptly.     

Traumatic rupture of the extensor pollicis longus tendon

Rupture of the extensor pollicis longus tendon is rather rare, attributable in about half of all cases to rheumatoid arthritis affecting the wrist or to a Colles' fracture. In the remainder of cases, either a direct closed injury to the wrist or a hyperextension injury of the wrist is most often responsible. Far more unusual is a rotational injury which can cause complete avulsion of the EPL tendon at the musculotendinous junction. A delayed rupture is most probably caused by an avascular necrosis secondary to traumatic disruption of the mesotendon. Surgical correction of the injury is best accomplished by tendon transfer, using the extensor indicis proprius. Postoperative immobilization, hyperextension of the thumb, and adequate resting tension are all necessary to assure good return of function. Postoperatively, the patient may experience a slight decrease in extensor strength of the index finger which may or may not be accompanied by a minimal loss in extensor range.     

Spontaneous rupture of the extensor pollicis longus tendon

An extensor pollicis longus tendon, ruptured after treatment of a giant cell tumor of the distal radius by packing the cavity with polymethylmethacrylate cement. The lack of extension was treated successfully with tendon transfer of the extensor indicis proprius to the extensor pollicis longus. Pathophysiology of the rupture is discussed.