Concomitant Extensor Pollicis Longus and Extensor Digitorum Longus Tendon Rupture may Complicate Surgical Reconstruction following Volar Plate Fixation of the Distal Radius: A Case Report

INTRODUCTION: Hardware prominence is one of the major established complications following volar plating of distal radius fractures. In particular, dorsal prominence of screws is the leading risk factor associated with post-surgical extensor pollicis longus (EPL) tendon rupture. Although there are many descriptions of attritional EPL ruptures in the literature, concomitant presentation of attritional EPL and extensor digitorum communis (EDC) ruptures following volar plating of distal radius fractures are minimal. CASE REPORT: We present a case of concomitant rupture of the EPL and occult rupture of the EDC to the index finger following volar plating of the distal radius. This was discovered intraoperatively and complicated the proposed tendon transfer reconstruction. CONCLUSION: Locked volar plate fixation has become the preferred technique for surgical management of distal radius fractures. The complication of multiple extensor tendon ruptures is rare but nevertheless may be encountered. We discuss strategies for diagnosis, treatment, and prevention. Surgeons should be aware of and prepared to proceed with alternative reconstructive procedures if this complication is discovered.