Autogenous palmaris longus tendon grafting for rupture of extensor pollicis longus tendon after distal radius fractures

Background: Secondary rupture of the extensor pollicis longus (EPL) tendon is a known complication following distal radius fracture. While surgical options for EPL tendon tear have been extensively investigated, the surgical results of free tendon graft reconstruction for patients with EPL tendon rupture after distal radius fracture are relatively unexplored. Purpose: We aimed to investigate the outcomes of autogenous palmaris longus (PL) tendon grafting for treating EPL tendon rupture after distal radius fracture. Methods: The study included 9 adult patients (2 male, 7 female; age range, 30-78 years; mean age, 56.7 years) with delayed EPL tendon rupture after distal radius fracture treated at the Taoyuan Armed Forces General Hospital between September 2000 and September 2011. In our hospital, we adopted a protocol for EPL tendon reconstruction that uses the ipsilateral PL tendon. A dynamic splint was applied, and a rehabilitation program including wrist motion and occupational therapy was started within 3 days postoperatively. Extension lag at the interphalangeal joint of the injured thumbs, as well as Geldmacher scores were recorded. Results: At the final follow-up (15-34 months), the extension lag at the interphalangeal joint of the involved thumb had improved significantly (p ＜ 0.05), from a preoperative mean value of 41.7° (range, 35°-60°) to a postoperative mean value of 3.8° (range, 0°-6°). Regarding the Geldmacher scores, 5 patients (55%) achieved ＂excellent＂ results, and 4 (45%) achieved ＂good＂ results. No patients experienced tendon re-rupture, wound infections, nerve injury, or other complications. Conclusions: In this short-term follow-up study, using free PL grafts for treating EPL tendon rupture was found to provide good outcomes, suggesting that tendon grafting using the PL tendon is an effective method to treat delayed EPL tendon rupture after distal radius fracture.