title: Extensor Pollicis Longus Ruptures Following Distal Radius Osteotomy Through a Volar Approach.
abstract: OBJECTIVE
  To investigate the cause and pathological process of extensor pollicis longus (EPL) ruptures after correction of distal radius malunion through a volar approach.
  
  
  METHODS
  We included patients with EPL ruptures who underwent distal radius osteotomies performed through a volar approach. Data were pooled from members of the International Wrist Investigators Workshop. Patient demographics, initial injury parameters, imaging studies, preoperative and postoperative examination, intraoperative findings, surgical technique, and outcomes were compared and analyzed. Preoperative and postoperative radiographic images were evaluated and compared.
  
  
  RESULTS
  We evaluated 6 cases from 5 surgeons in 4 institutions. Length of follow-up ranged from 1 to 5 years. On initial radiographic evaluation all malunions were healed with dorsal angulation (20° to 60°) and with positive ulnar variance. Deformity correction in the sagittal plane was 25° to 55°. Osteotomies were fixed with volar locking plates with autologous bone graft except for one patient who received calcium phosphate-based bone void filler. Postoperative x-rays suggested prominent osteotomy resection edges, osteophytes, or dorsal bony prominence resulting from healed callus. Average time from osteotomy to EPL rupture was 10 weeks (range, 2-17 weeks). Two patients initially refused to undergo tendon transfers. One was pleased with the outcome despite the ruptured EPL. The other patient ruptured 2 more tendons and chose to have tendon transfers. One patient also ruptured the transferred tendon after 2 months and underwent successful tendon grafting.
  
  
  CONCLUSIONS
  In the absence of screw prominence and technical flaws, it is likely that dorsal callus, prominent osteotomy resection edges, and osteophytes may contribute to attritional rupture of the EPL tendon after a corrective osteotomy through a volar approach. Exposure and debridement of excessive callus, dorsal ridge, or a prominent Lister tubercle performed during the osteotomy may reduce subsequent EPL rupture.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Hand and Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA. Electronic address: Michael.Rivlin@rothmaninstitute.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Rivlin
authors.affiliation: Department of Orthopaedic Surgery, Lindenhof Hospital, Bern, Switzerland.
authors.forename: Diego L
authors.initials: DL
authors.lastname: Fernández
authors.affiliation: Department of Hand Surgery, The Balgrist University Clinic, Zürich, Switzerland.
authors.forename: Ladislav
authors.initials: L
authors.lastname: Nagy
authors.affiliation: Ibermutuamur Clinic, Madrid, Spain.
authors.forename: Gabriel López
authors.initials: GL
authors.lastname: Graña
authors.affiliation: Department of Hand and Upper Extremity Surgery, Massachusetts General Hospital, Harvard University, Boston, MA.
authors.forename: Jesse
authors.initials: J
authors.lastname: Jupiter
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017759:Fractures, Malunited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology*; D011885:Radius Fractures / Q000601:surgery*; D012421:Rupture; D013708:Tendon Injuries / Q000209:etiology*
keywords: Malunion; reconstruction of the wrist; surgical risks; tendon rupture; wrist deformity