FPL Reconstruction After Rupture Following Volar Plate Fixation of Distal Radius Fractures: A Case Series

Purpose: Volar locking plate (VLP) of distal radius fractures (DRF) carries a number of surgical risks including flexor pollicis longus (FPL) rupture secondary to irritation from prominent hardware. This study reviews FPL reconstruction (with interposition graft or tendon transfer) after VLP-related rupture. Methods: This retrospective case series reports the experience at one tertiary center with FPL reconstruction after DRF. Patients treated between January 1, 2013, and June 12, 2023, were eligible for inclusion. Preoperative radiographs were analyzed for Soong grading and fracture reduction parameters. Accessible patients (n = 7) were examined to evaluate long-term success of reconstruction. Results: Fifteen patients (average age: 63 years) underwent VLP removal and reconstruction to restore FPL function. Rupture occurred at a median of 6 years 3 months after DRF repair (range: 1.8 months to 17 years). Eleven patients had accessible radiographs after plate fixation, all with Soong grade of 1 or 2. Eight patients underwent ring finger flexor digitorum superficialis to FPL transfer, whereas seven were treated with free tendon interposition autograft with palmaris longus (5) or flexor carpi radialis (2). One patient with systemic lupus erythematosus had a rerupture. Of the seven patients available for interview at the time of data collection, mean thumb interphalangeal joint flexion was 35°, whereas mean patient-reported outcomes measurement information system score was 48. Conclusions: Flexor pollicis longus rupture is a known complication of VLP fixation of DRF, occurring over a wide range of time after initial fracture fixation. In cases of rupture, we have had success reconstructing FPL using tendon transfers or interposition autografts, with improvement seen after both techniques. Type of study/level of evidence: Therapeutic IV.