Outcomes of Flexor Pollicis Longus Reconstruction for Volar Plate Related Ruptures

Arno A. Macken; Jonathan Lans; Sezai Özkan; Simon Kramer; Jesse B. Jupiter; Neal C. Chen

doi:10.1055/s-0041-1739961

Journal of Hand and Microsurgery, Table of Contents

J Hand Microsurg 2023; 15(03): 212-218
DOI: 10.1055/s-0041-1739961

Original Article

Outcomes of Flexor Pollicis Longus Reconstruction for Volar Plate Related Ruptures

Authors

Arno A. Macken

¹Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
Jonathan Lans

¹Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
Sezai Özkan

¹Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
Simon Kramer

¹Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
Jesse B. Jupiter

¹Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
Neal C. Chen

¹Department of Orthopedic Surgery, Orthopedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States

Abstract

Aim A rare complication following volar plate fixation of a distal radius fracture is flexor pollicis longus (FPL) rupture. This study aims primarily to analyze the radiographic features and secondly to report the patient-reported outcomes of FPL reconstruction after volar plate fixation.

Methods Ten patients were retrospectively identified and contacted for follow-up. Seven patients participated in the study and completed the numeric rating scale (NRS) for pain, patient-reported outcome measurement information system—upper extremity (PROMIS-UE), and quick disability of arm, shoulder, and hand (QuickDASH) questionnaires at a median of 3.4 years following FPL reconstruction. Soong grade was determined on preoperative radiographs.

Results Six patients were classified as Soong grade 1 and two patients had a screw or wire protruding volarly. The median time to tendon rupture was 21.6 months. At final follow-up, the median NRS pain score was 0 (range: 0–7); the median PROMIS-UE score was 47.1 (range: 25.9–61); and the median QuickDASH-score was 12.5 (range: 4.5–75).

Conclusions The outcome of FPL reconstruction after volar plate fixation is highly variable. All ruptures in our cohort occurred in patients with plate positioning classified as Soong grade 1 and occurred at up to 3 years following distal radius fixation.

Keywords

distal radius fracture - flexor pollicis longus - tendon - attrition - rupture - patient-reported outcome - soong grade

Full Text

References

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