Technical tip: Side-to-side tendon suture as escape plan during extensor indicis tendon plasty in distal extensor pollicis longus rupture

Abstract

Objective: In case of a short distal recipient stump after extensor pollicis longus (EPL) tendon rupture, transfer of the extensor indicis proprius (EIP) tendon using a conventional Pulvertaft tendon-weaving technique may be difficult or impossible. The purpose of this paper is to provide a technical tip to manage this rare, but clinically important scenario of a very short distal EPL recipient tendon.Methods: A side-to-side tendon suture (SSTS) was used for EIP transfer to restore thumb extension in 3 patients who had sustained a distal rupture of their extensor pollicis longus near the interphalangeal joint. The SSTS was performed with an overlap of 2 cm in 2 patients and in one patient.Results: A stable SSTS was achieved which allowed early active mobilization and resulted in good functional recovery of thumb extension after a mean follow-up of 8 months.Conclusion: Extensor indicis transfer using SSTS is a reliable and technically simple escape plan in a distal rupture of the EPL near the phalangeal joint. It provides very stable tendon-to-tendon attachment with high loading capacity and good gliding qualities.

Keywords

• technical tip
• side-to-side tendon suture
• Pulvertaft
• weaving
• immediate mobilization