Flexor Pollicis Tendon Rupture After Volar Plating of Distal Radius Fracture

Author(s): Amanda Partap, Trevor Seepaul, Ryan Raghunanan

Introduction: Distal radius fractures are one of the commonest fractures seen worldwide with a steadily rising incidence. There are numerous treatment options available for their management with the most recent advancement being the use of volar locking plates. These locking plates despite advancement in their design and biomechanical construct have been shown to result in flexor tendon rupture and tenosynovitis in up to 15% of patients.

Case Report: A 70-year-old female underwent open reduction and internal fixation with a 3.5 mm volar locking plate for the treatment of a right intra-articular distal radius fracture with volar displacement. Twenty-six (26) months after the initial procedure she re-presented with the inability to flex her thumb after reaching for an object one month prior. The patient subsequently underwent surgical exploration to address her FPL tendon rupture with reconstruction utilising ipsilateral palmaris longus graft with a Pulvertaft weave for both proximal and distal anastomoses.

Conclusion: The reconstruction technique employed in this case yielded a good functional outcome for this patient. The pulvertaft weave as a proximal and distal anastomosis suture provides a good option for reconstruction once there is sufficient graft length to permit its use on both ends.