[Secondary tendon reconstruction on the thumb].

Area of Science:

• Orthopedics
• Hand Surgery
• Musculoskeletal Research

Background:

• Closed ruptures of thumb tendons, including the extensor pollicis longus (EPL), extensor pollicis brevis (EPB), and flexor pollicis longus (FPL), necessitate secondary reconstruction.
• These ruptures often occur secondary to distal radius fractures or post-surgical complications.

Purpose of the Study:

• To outline current treatment strategies for closed ruptures of the EPL, EPB, and FPL tendons.
• To discuss surgical options, including tendon transfer, graft interposition, tenodesis, and arthrodesis, for thumb tendon injuries.

Main Methods:

• Review of treatment protocols for closed EPL, EPB, and FPL tendon ruptures.
• Discussion of surgical techniques such as refixation, joint transfixation, tendon transfer (e.g., extensor indicis to EPL), tendon graft interposition (e.g., palmaris longus), tenodesis, and arthrodesis.
• Intraoperative assessment using the tenodesis test for tensioning.

Main Results:

• EPB rupture treatment involves refixation and joint transfixation; arthrodesis is preferred for arthritic cases.
• EPL ruptures post-distal radius fracture may be managed with extensor indicis tendon transfer or palmaris longus graft interposition.
• Closed FPL ruptures often occur after distal radius osteosynthesis and can be prevented by early plate removal, synovectomy, or carpal tunnel release. Treatment options include reconstruction, tenodesis, or arthrodesis.

Conclusions:

• Management of closed thumb tendon ruptures requires tailored approaches based on the affected tendon (EPL, EPB, FPL) and underlying pathology.
• Surgical interventions range from direct repair and tendon transfers to joint fusion, with the goal of restoring thumb function.
• Preventive measures for FPL ruptures include optimizing surgical techniques and timely hardware removal.