A 2-free-end flexor carpi radialis tendon graft for treating a complex index finger extensor tendon injury

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Giovanni Battista Colasanti
Carlotta Pari
Agnese Puzzo
Stefania Paderni
Claudio Goretti
Alberto Belluati


KEYWORDS: Distal Radius Volar Plating, Extensor Tendon Injuries, FCR tendon Graft


Background: Volar plating has increasingly become the most used technique for the treatment
of unstable distal radius fractures due to the low soft-tissue disturbance and its biomechanical reliability,
which allows the early mobilization of the wrist. One of the main goals of the volar locking compression
plates design is to avoid those soft tissue complications historically associated to the dorsal plating. However,
extensor tendon complications can not be completely excluded. Method: The authors report the case of a
patient with a complete rupture of the index finger extensor tendons after volar plate fixation of the distal
radius. Due to the presence of a severe tendons retraction with a 4-centimeter gap and the neighbouring
soft tissues damage, it was decided to fill the gap with a 2-free-end autograft harvested from the Flexor
Carpi Radialis (FCR) tendon, using the volar surgical approach performed to remove the plate. Results:
At the 2-month follow-up, the patient showed the complete recovery of the flexion-extension movements.
Conclusions: Even though the 2-free-end FCR tendon graft is not commonly reported for the reconstruction
of extensor tendons defects, we assume it deserves to be considered as an adequate technique whenever the
neighbouring tendons are critically compromised.


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[1] C. M. Court-Brown and B. Caesar, “Epidemiology of adult fractures: A review,” Injury 2006; 37: 691–697.
[2] R. Arora, M. Lutz, A. Hennerbichler, D. Krappinger, D. Espen, and M. Gabl, “Complications following internal fixation of unstable distal radius fracture with a palmar locking-plate,” J. Orthop. Trauma 2007; 21: 316–322.
[3] L. M. Berglund and T. M. Messer, “Complications of volar plate fixation for managing distal radius fractures,” Journal of the American Academy of Orthopaedic Surgeons 2009; 17: 369-77.
[4] Y. Totoki, Y. Yoshii, T. Kusakabe, K. Akita, and T. Ishii, “Screw Length Optimization of a Volar Locking Plate Using Three Dimensional Preoperative Planning in Distal Radius Fractures,” J. hand Surg. Asian-Pacific Vol. 2018; 23: 520-527.
[5] D. Dolce, D. Goodwin, M. Ludwig, and S. Edwards, “Intraoperative evaluation of dorsal screw prominence after polyaxial volar plate fixation of distal radius fractures utilizing the Hoya view: a cadaveric study,” Hand 2014; 9: 511–515.
[6] B. W. Hill, I. Shakir, and L. K. Cannada, “Dorsal screw penetration with the use of volar plating of distal radius fractures: How can you best detect?,” J. Orthop. Trauma 2015; 29: 408–413.
[7] D. Marsland, C. M. Hobbs, and P. S. Sauvé, “Volar locking plate fixation of distal radius fractures: use of an intra-operative ‘carpal shoot through’ view to identify dorsal compartment and distal radioulnar joint screw penetration,” Hand 2014; 9: 516-21.
[8] A. P. Riddick, B. Hickey, and S. P. White, “Accuracy of the skyline view for detecting dorsal cortical penetration during volar distal radius fixation,” J. Hand Surg. Eur. Vol. 2012; 37: 407–411.
[9] M. Al-Rashid, K. Theivendran, and M. A. C. Craigen, “Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures,” J. Bone Jt. Surg. - Ser. Br 2006; 88: 1610-2.
[10] M. H. M. Lemmen, T. A. R. Schreuders, H. J. Stam, and S. E. R. Hovius, “Evaluation of restoration of extensor pollicis function by transfer of the extensor indicis,” J. Hand Surg. Eur. Vol. 1999; 24: 46-9.
[11] T. Türker, K. Hassan, and N. Capdarest-Arest, “Extensor tendon gap reconstruction: A review,” Journal of Plastic Surgery and Hand Surgery 2016; 50: 1-6 .
[12] M. M. Al-Qattan, “Two-staged extensor tendon reconstruction for zone 6 extensor tendon loss of the fingers: Indications, technique and results,” J. Hand Surg. Eur. Vol. 2015; 40: 276-8.
[13] B. K. Potu, V. Kumar, S. Annam, and S. R. Sirasanagandla, “A morphometric study on flexor carpi radialis muscle of the forearm: A cadaveric study,” Morphologie 2016; 100: 12-6.
[14] M. Henry, “Outcomes assessment of lunate replacement arthroplasty with intrinsic carpal ligament reconstruction in Kienböck’s disease,” Hand 2014; 9: 364-9.
[15] G. A. Brunelli and G. R. Brunelli, “A new technique to correct carpal instability with scaphoid rotary subluxation: A preliminary report,” J. Hand Surg. Am. 1995; 20: 82-5.

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