Functional results after extensor indicis proprius to extensor pollicis longus tendon transfer for ruptures associated with distal radius fractures
DOI:
https://doi.org/10.2340/jphs.v61.46150Keywords:
EPL rupture, EIP transfer, distal radius fracture, functional outcome, patient-reported outcomeAbstract
Rupture of the extensor pollicis longus (EPL) tendon is a recognised complication after distal radius fracture (DRF) that leads to loss of active thumb extension. Transfer of the extensor indicis proprius (EIP) tendon to the EPL is one of the most common reconstructive procedures, but prospective outcome data are limited. This study evaluated functional and patient-reported outcomes after EIP-to-EPL tendon transfer exclusively in patients with EPL rupture secondary to DRF. Thirty consecutive patients (26 women, 4 men; median age 65 years, range 17–80) underwent EIP-to-EPL tendon transfer between 2021 and 2025 for EPL rupture secondary to DRF. Thumb motion, grip and pinch strength and QuickDASH scores were recorded at 3 and 6 months postoperatively. All motion parameters improved between 3 and 6 months. At 6 months, lift-off height recovered to approximately two-thirds, total thumb flexion to > 80% and radial/palmar abduction to about 90% of the contralateral side. Grip and pinch strength reached 79–85% of the uninjured hand. Mean QuickDASH score improved from 29 to 21 points (p = 0.015). In conclusion, EIP-to-EPL tendon transfer restores satisfactory thumb motion, strength and patient-rated function following EPL rupture associated with DRF. Functional recovery at 6 months is comparable to that of patients with uncomplicated DRFs.
Clinical Trials registry no. NCT05264675
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D’Antoni AV. Gray’s anatomy, the anatomical basis of clinical practice, forty‐first edition, by Susan Standring, Editor‐in‐Chief, Elsevier Limited, 2016. ISBN: 978‐0‐7020‐5230‐9. Rochester: Wiley Subscription Services, Inc; 2016. p. 264–265. DOI: https://doi.org/10.1002/ca.22677
Gelb RI. Tendon transfer for rupture of the extensor pollicis longus. Hand Clin. 1995;11(3):411–422. DOI: https://doi.org/10.1016/S0749-0712(21)00062-7
Bjorkman A, Jorgsholm P. Rupture of the extensor pollicis longus tendon: a study of aetiological factors. Scand J Plast Reconstr Surg Hand Surg. 2004;38(1):32–35. DOI: https://doi.org/10.1080/02844310310013046
Sarigiannis CN, Ullman M, Andreasson I, et al. Inflammatory and degenerative changes in the extensor pollicis longus muscle and tendon following ruptures caused by distal radius fractures. BMC Musculoskelet Disord. 2025;26(1):10. DOI: https://doi.org/10.1186/s12891-024-08212-4
Hove LM. Delayed rupture of the thumb extensor tendon. A 5-year study of 18 consecutive cases. Acta Orthop Scand. 1994;65(2): 199–203. DOI: https://doi.org/10.3109/17453679408995434
Sato K, Murakami K, Mimata Y, et al. Incidence of tendon rupture following volar plate fixation of distal radius fractures: a survey of 2787 cases. J Orthop. 2018;15(1):236–238. DOI: https://doi.org/10.1016/j.jor.2018.01.030
White BD, Nydick JA, Karsky D, et al. Incidence and clinical outcomes of tendon rupture following distal radius fracture. J Hand Surg Am. 2012;37(10):2035–2040. DOI: https://doi.org/10.1016/j.jhsa.2012.06.041
Roth KM, Blazar PE, Earp BE, et al. Incidence of extensor pollicis longus tendon rupture after nondisplaced distal radius fractures. J Hand Surg Am. 2012;37(5):942–947. DOI: https://doi.org/10.1016/j.jhsa.2012.02.006
Engkvist O, Lundborg G. Rupture of the extensor pollicis longus tendon after fracture of the lower end of the radius – a clinical and microangiographic study. Hand. 1979;11(1):76–86. DOI: https://doi.org/10.1016/S0072-968X(79)80015-7
Kunes JA, Hong DY, Hellwinkel JE, et al.. Extensor tendon injury after volar locking plating for distal radius fractures: a systematic review. Hand (N Y). 2022;17(1_suppl):87S–94S. DOI: https://doi.org/10.1177/15589447211068186
Ganon S, Bellity J, Zbili D, et al. Reconstruction strategies after rupture of the extensor pollicis longus tendon: a systematic review. Hand Surg Rehabil. 2020;39(6):502–507. DOI: https://doi.org/10.1016/j.hansur.2020.07.005
Ha C, Hong IT, Oh CH, et al. Clinical outcomes of extensor indicis proprius tendon transfer for extensor pollicis longus tendon rupture. J Hand Surg Eur Vol. 2024;49(10):1243–1249. DOI: https://doi.org/10.1177/17531934241226949
Adams AJ, Patel SJ, Arango SD, et al. Extensor tendon transfer for fracture-related extensor pollicis longus rupture: long-term outcome case series. J Hand Ther. 2024;37(4):529–533. DOI: https://doi.org/10.1016/j.jht.2024.02.004
Stirling ERB, Johnson NA, Dias JJ. Epidemiology of distal radius fractures in a geographically defined adult population. J Hand Surg Eur Vol. 2018;43(9):974–982. DOI: https://doi.org/10.1177/1753193418786378
Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113–125. DOI: https://doi.org/10.1016/j.hcl.2012.02.001
Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26(5):908–915. DOI: https://doi.org/10.1053/jhsu.2001.26322
Tsiampa V, Ignatiadis I, Papalois A, et al. Structural and mechanical integrity of tendon-to-tendon attachments used in upper limb tendon transfer surgery. J Plast Surg Hand Surg. 2012;46: 262–266. DOI: https://doi.org/10.3109/2000656X.2012.684097
Sarigiannis CN, Andreasson I, Ekstrom L, et al. Normative data on extensor pollicis longus force, lift-off height, and tendon gliding amplitude. J Hand Ther. 2026 Mar 3:S0894-1130(25)00209-1. 2026. DOI: https://doi.org/10.1016/j.jht.2025.12.010
Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord. 2006;7:44. DOI: https://doi.org/10.1186/1471-2474-7-44
Meinberg EG, Agel J, Roberts CS, et al. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32 Suppl 1:S1–S170. DOI: https://doi.org/10.1097/BOT.0000000000001063
Figl M, Mayer M, Lederer S, et al. Extensor pollicis longus rupture after distal radius fracture: results of reconstruction by transposition of the extensor indicis tendon and postoperative dynamic splinting. Wien Klin Wochenschr. 2011;123(15–16): 485–487. DOI: https://doi.org/10.1007/s00508-011-0038-4
Lemmen MH, Schreuders TA, Stam HJ, et al. Evaluation of restoration of extensor pollicis function by transfer of the extensor indicis. J Hand Surg Br. 1999;24(1):46–49. DOI: https://doi.org/10.1016/S0266-7681(99)90025-6
Chung KC, Squitieri L, Kim HM. Comparative outcomes study using the volar locking plating system for distal radius fractures in both young adults and adults older than 60 years. J Hand Surg Am. 2008;33(6):809–819. DOI: https://doi.org/10.1016/j.jhsa.2008.02.016
Bobos P, Nazari G, Lalone EA, et al. Recovery of grip strength and hand dexterity after distal radius fracture: a two-year prospective cohort study. Hand Ther. 2018;23(1):28–37. DOI: https://doi.org/10.1177/1758998317731436
Brogren E, Hofer M, Petranek M, et al. Fractures of the distal radius in women aged 50 to 75 years: natural course of patient-reported outcome, wrist motion and grip strength between 1 year and 2–4 years after fracture. J Hand Surg (European Volume). 2011;36(7): 568–576. DOI: https://doi.org/10.1177/1753193411409317
Gummesson C, Atroshi I, Ekdahl C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord. 2003;4(1):11. DOI: https://doi.org/10.1186/1471-2474-4-11
MacDermid JC, Roth JH, Richards RS. Pain and disability reported in the year following a distal radius fracture: a cohort study. BMC Musculoskelet Disord. 2003;4:24. DOI: https://doi.org/10.1186/1471-2474-4-24
Jung SW, Kim CK, Ahn BW, et al. Standard versus over-tensioning in the transfer of extensor indicis proprius to extensor pollicis longus for chronic rupture of the thumb extensor. J Plast Reconstr Aesthet Surg. 2014;67(7):979–985. DOI: https://doi.org/10.1016/j.bjps.2014.03.006
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Copyright (c) 2026 Ingrid Andreasson, Christos Ni. Sarigiannis, Michael Ullman, Anders Björkman
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