Abstract
Introduction
Distal radius fracture is a main cause of spontaneous rupture of the extensor pollicis longus (EPL) tendon, and extensor indicis proprius (EIP) tendon transfer is a routine surgery to repair ruptured EPL tendon. 1 This report presents an unusual surgery for extensor digitorum communis II (EDC II) tendon transfer to repair the spontaneous ruptured EPL of a 36-year-old female patient who had a special requirement.
Patients and Methods
The patient had distal radius fracture on her right wrist 2 months before surgery and was treated with a splint immobilization in a local clinic. After approximately 6 weeks of immobilization, the patient’s right thumb lost active extension function during the following rehabilitation. The patient consequently presented at our hospital for further treatment. A Doppler ultrasound to detect the EPL verified it had lost its continuity at the fracture site. Extensor indicis proprius tendon transfer surgery was consequently recommended. However, the patient was a Chinese classical opera actress, and the isolated extension of her index finger was necessary for her performance. Due to this special situation, the EDC II tendon was alternatively elected to transfer to reconstruct the ruptured EPL tendon. During the operation, the EIP tendon was left intact. The other surgical techniques were the same as traditional EIP tendon transfer. The patient’s thumb was immobilized in the “hitch hiker” position with a thumb spica for 4 weeks post-operatively. Functional therapy began as soon as the splint was removed.
Results
The functional assessments were taken at the 2nd, 6th, 13th, and 25th month post-operative. In the follow-up period, the total active motion (TAM) of the thumb, index finger, middle finger, and wrist were measured. The patient completed the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire and Michigan Hand Outcomes Questionnaire (MHQ). The independent extension of her index finger and the extensor tendon dislocation of her middle finger were assessed. A dynamic Doppler ultrasound examined the continuity and glide of the repaired tendon after the cast was removed (Supplemental Material). At the final follow-up, all the patient’s TAM scores were excellent (Table 1). No obvious loss of thumb extension and flexion was found compared with the unoperated side. The MHQ score was 72.5, and the DASH score was a functional value of 2.5. The isolated extension of the patient’s thumb and index finger was possible. No extensor tendon dislocation was found in her middle finger. All of the evaluations demonstrated excellent results (Figure 1).
Function of the involved hand at the last following-up.
Outcome Measures at the Second Year Following Tendon Transfer.
Abbreviation: DIPJ, Distal interphalangeal joint; IPJ, Interphalangeal joint; MCPJ, Metacarpal phalangeal joint; PIPJ, Proximal interphalangeal joint; TAM, total active motion.
Discussion
Tendon grafting has been successfully used to achieve the restoration of EPL function in cases when spontaneous rupture of the EPL tendon occurs at the level of the wrist. 2 However, in cases of radius fracture, there is a risk of tendon abrasion since the grafted tendon passes the fracture site. This procedure requires 2 tendon repair sites, and myostatic contracture must be overcome for appropriate tensioning. 3 Thus, EIP tendon transfer is commonly used to restore the loss of function in spontaneous EPL tendon rupture secondary to distal radius fracture. 4 However, many variations in the anatomy of the extensor indicis muscle and tendon have been described. 5 In 2004, Bryce and Earl reported 2 patients who had their EDC II tendons transferred to repair ruptured EPL tendons, achieving satisfactory results. 3 Both Bryce’s report and ours provide an alternative treatment for spontaneous EPL tendon rupture, especially for patients with anatomical variations in the EIP tendon or who have certain occupations. Further research is necessary to confirm these results.
Supplemental Material
Supplemental - Transfer of the Index Finger Extensor Digitorum Communis Tendon to the Extensor Pollicis Longus Tendon: A Case Report
Supplemental for Transfer of the Index Finger Extensor Digitorum Communis Tendon to the Extensor Pollicis Longus Tendon: A Case Report by Xin Zhao and Jin Li in Plastic Surgery Case Studies
Footnotes
References
Supplementary Material
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