Extensor pollicis longus rupture at the tip of a prominent fixation screw: report of three cases

Rupture of the extensor pollicis longus tendon at the tip of a prominent fixation screw occurred in two cases after fixation of fractures of the radial shaft and in one case after fixation of a fracture of the scaphoid. Patients were referred because of their inability to extend the thumb. Active thumb extension was restored in two patients by screw removal and tendon transfer. The third patient elected nonoperative care. Close scrutiny of good-quality intraoperative x-ray films after internal fixation about the wrist may detect screws that are too prominent and thereby prevent rupture of the extensor pollicis longus tendon.