Subcutaneous rupture of the extensor pollicis longus [EPL] tendon after nondisplaced fracture of the distal radius is a well known complication, which however can also be seen in displaced fractures or as a late complication after open reduction and internal fixation [ORIF] of the distal radius. We describe seven EPL tendon ruptures occurring with distal radius fractures in this article. The age of the patients ranged from 18 years to 77 years [mean: 53 years]. Rupture occurred at 202 days and 150 days from the operation for distal radius fracture in the ORIF group. In the non-operated group, rupture occurred at a median of 30 days [range: 25 days to 32 days] from the time of the fracture.
Of these, one case had displaced fracture, and the other cases had nondisplaced fractures. Several possible mechanisms are discussed in literature, such as anatomical characteristics of EPL tendon, mechanical irritation of the tendon caused by a sharp edge of the fracture bone or a metal edge of the screw or K-wire, and direct or indirect microvascuular compromise of the poorly vascularised tendon. Not only simple causes but also many complicated causes are involved in these cases. Tendon transfer or free palmaris longus graft yields excellent results after EPL tendon rupture.
