Adequate Tension and Clinical Results of Palmaris Longus Tendon Interpositional Graft in Closed Flexor Pollicis Longus Rupture

Volar plate fixation for distal radial fractures is the most common cause of closed rupture of the flexor pollicis longus tendon (FPL). For treating a closed FPL rupture, transferring the fourth flexor digitorum superficialis or a tendon graft from the palmaris longus (PL) can be performed. This stu...

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Bibliographic Details
Published in:Clinics in orthopedic surgery Vol. 17; no. 3; pp. 506 - 513
Main Authors: Lee, Joonha, Ku, Ki Hyeok, Lee, Jae Hoon, Baek, Jong Hun
Format: Journal Article
Language:English
Published: Korea (South) The Korean Orthopaedic Association 01.06.2025
대한정형외과학회
Subjects:
Adult
Aged
Female
Fracture Fixation, Internal - adverse effects
Humans
Male
Middle Aged
Original
Radius Fractures - surgery
Retrospective Studies
Rupture - surgery
Tendon Injuries - etiology
Tendon Injuries - surgery
Tendon Transfer - methods
Tendons - transplantation
정형외과학
Tendinopathy
Tendon injuries
Tendon transfer
Thumb
Wrist fractures
ISSN:2005-291X, 2005-4408, 2005-4408
Online Access:Get full text
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Summary:Volar plate fixation for distal radial fractures is the most common cause of closed rupture of the flexor pollicis longus tendon (FPL). For treating a closed FPL rupture, transferring the fourth flexor digitorum superficialis or a tendon graft from the palmaris longus (PL) can be performed. This study reports the results of tendon grafting using the PL in closed FPL rupture and discusses the provision of optimal tendon tension. This retrospective study included 11 out of 20 patients who underwent PL tendon graft for closed FPL rupture between 2013 and 2022, with a follow-up period of more than 12 months. There were 4 men and 7 women, with an average age of 62 years. The average period from the date of rupture to surgery was 39 days. Ruptures occurred due to volar plate fixation in 7 cases, ithout a specific cause in 2 cases, and after a steroid injection for trigger thumb in 2 cases. The rupture site was in zone 2 in 4 cases and zone 5 in 7 cases. The mean follow-up period was 59 months. Optimal tension for the grafted tendon was determined by comparing the intraoperative angles of the interphalangeal (IP) and metacarpophalangeal (MCP) joints with the angles of the same joints at the final follow-up. At the final follow-up, the mean IP joint motion was 61.0°, which was 81.5% of the contralateral side. The average range of motion of the MCP joint was 43.6°, which was 80.0% of the contralateral side. The pinch power was 90.8% of the contralateral side. Cases with > 70° IP joint motion were those in which the IP joint angle was > 45° during surgery. Moreover, the greater the flexion of the IP and MCP joints intraoperatively, the better the range of motion of the IP joints. Tendon grafting using the PL is recommended as an effective surgical method to achieve 81.5% of contralateral IP joint motion in cases of closed FPL tendon rupture. Over-tensioning of the tendon graft with IP Joint flexion more than 45° during surgery is recommended.
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Joonha Lee and Ki Hyeok Ku contributed equally to this work as co-first authors.
https://ecios.org/DOIx.php?id=10.4055/cios24254
ISSN:2005-291X
2005-4408
2005-4408
DOI:10.4055/cios24254