[Replacement of the long extensor tendon of the thumb by transposition of the index finger extensor tendon]

Abstract

Transposition of the extensor indicis seems to be the most common procedure for reconstruction of the ruptured or severed extensor pollicis longus (EPL) tendon. From 1959 to 1988, we performed 115 extensor indicis transpositions in 34 open EPL injuries and 81 subcutaneous EPL ruptures. The open injuries involved failed primary repair (n = 6) or untreated tendon injuries (n = 19). The subcutaneous ruptures occurred after distal radius fractures or other closed injuries of the wrist (n = 62), arthrosis or rheumatoid synovialitis (n = 8). Forty-seven patients returned for follow-up examination six months to 18 years after operation. The evaluation included twelve parameters involving thumb, index finger and overall hand function as well as subjective patient assessment. We found significant loss of motion and strength only in two cases, where the tension of the transposed tendon was obviously inadequate. A certain loss of independent index extension was without functional impairment. Although several authors prefer EPL reconstruction with an intercalated tendon graft, we recommend the extensor indicis transposition as a simple procedure with predictable satisfactory results.