FPL Reconstruction After Rupture Following Volar Plate Fixation of Distal Radius Fractures: A Case Series

Area of Science:

• Orthopedic surgery
• Hand surgery
• Trauma reconstruction

Background:

• Volar locking plates (VLP) for distal radius fractures (DRF) can lead to flexor pollicis longus (FPL) tendon rupture due to prominent hardware.
• This complication can significantly impair thumb function and hand dexterity.

Purpose of the Study:

• To review the outcomes of flexor pollicis longus (FPL) reconstruction following rupture secondary to volar locking plate (VLP) fixation in distal radius fractures (DRF).
• To evaluate the efficacy of tendon transfer and interposition autograft techniques for FPL reconstruction.

Main Methods:

• A retrospective case series of patients undergoing FPL reconstruction after VLP-related rupture between January 1, 2013, and June 12, 2023.
• Analysis of preoperative radiographs for Soong grading and fracture reduction.
• Evaluation of long-term success in accessible patients (n=7) through clinical examination and patient-reported outcome measures.

Main Results:

• Fifteen patients (average age 63) underwent VLP removal and FPL reconstruction.
• Rupture occurred at a median of 6 years 3 months post-DRF repair.
• Eight patients had flexor digitorum superficialis to FPL transfer; seven had free tendon interposition autografts (palmaris longus or flexor carpi radialis).
• Seven patients available for follow-up showed mean thumb interphalangeal joint flexion of 35° and a mean PROMIS score of 48.

Conclusions:

• Flexor pollicis longus (FPL) rupture is a recognized complication of volar locking plate (VLP) fixation for distal radius fractures (DRF), occurring over a wide time frame.
• Both tendon transfer and interposition autograft techniques demonstrate success in reconstructing FPL function after rupture, leading to functional improvement.