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Case Reports
. 2025 Aug;15(8):91-95.
doi: 10.13107/jocr.2025.v15.i08.5896.

Flexor Pollicis Longus Tendon Rupture after Distal Radius Volar Plating and Reconstruction with Interpositional Palmaris Tendon Graft: A Case Report

Jon Hammarstedt  1 , Kyle Holmberg  2 , Yehuda Masturov  3 , Todd Turner  4 , Gonzalo Sumarriva  2 , Steven Regal  2
Affiliations
Case Reports

Flexor Pollicis Longus Tendon Rupture after Distal Radius Volar Plating and Reconstruction with Interpositional Palmaris Tendon Graft: A Case Report

Jon Hammarstedt et al. J Orthop Case Rep. 2025 Aug.

Abstract

Introduction: Distal radius fractures constitute one of the most prevalent upper extremity orthopedic injuries, predominantly resulting from falls onto an outstretched hand with an extended wrist. Despite volar locking plate fixation emerging as the gold standard treatment for distal radius fractures, it is associated with well-documented complications, such as flexor pollicis longus (FPL) tendon irritation and even rupture. The surgical management of FPL tendon rupture following volar plate fixation poses significant challenges due to hardware-induced tendon attrition and compromised surgical exposure. This case report is the first documented case utilizing interpositional palmaris tendon autografting for FPL tendon rupture as a complication of volar locking plate fixation with volar locking plate fixation.

Case report: The patient is a 62-year-old left-sided dominant female who underwent successful open reduction internal fixation with a volar locking plate for a distal radius fracture treated for a distal right radius fracture with a volar locking plate. The patient was 5 months post-operatively with acute loss of thumb interphalangeal joint flexion in the absence of preceding trauma. Following patient evaluation and discussion of alternative treatments, the patient underwent concurrent hardware removal and FPL tendon reconstruction with interpositional palmaris tendon autografting.

Conclusion: A clear consensus regarding the treatment of FPL tendon ruptures in the setting of distal radius fractures treated with volar plating has not been established in the present orthopedic literature. This case represents the first reported utilization of an interpositional palmaris tendon graft for FPL rupture following distal radius volar plating. The authors of this study propose this technique as a viable treatment option for FPL tendon rupture in patients with prior distal radius fractures treated with volar locking plate fixation.

Keywords: Distal radius fracture; autograft; plate fixation; tendon rupture.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
AP and lateral radiographs showing comminuted intra-articular distal radius fracture with 40° dorsal angulation.
Figure 2
Figure 2
AP and lateral views at 5 months: Healed distal radius with volar plate placement.
Figure 3
Figure 3
Proximal and distal ends of ruptured flexor pollicis longus tendon.
Figure 4
Figure 4
The PL tendon autograft after four Pulvertaft weaves into the distal portion of the flexor pollicis longus tendon.
Figure 5
Figure 5
Flexed position of the thumb demonstrating appropriate tension of the flexor pollicis longus reconstruction.
Figure 6
Figure 6
Post-operative range of motion at 1-year follow-up.
Figure 7
Figure 7
Post-operative range of motion at 1-year follow-up.
See this image and copyright information in PMC

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