Silent for Ten Years: Late Flexor Pollicis Longus Rupture Following Volar Plate Fixation of the Distal Radius

Flexor pollicis longus (FPL) tendon rupture is an uncommon complication following volar locking plate fixation for distal radius fractures and is most often attributed to attritional wear from hardware contact. While most reported cases occur within the first few years after open reduction and internal fixation (ORIF), rupture occurring a decade or more after surgery remains exceedingly rare. A 48-year-old, left-hand-dominant male field engineer presented with a two-week history of inability to flex the interphalangeal (IP) joint of his left thumb. The symptoms began acutely while lifting heavy boxes at work and were preceded by sharp wrist pain. Ten years prior, he underwent ORIF of a left distal radius and ulnar styloid fracture after he fell from a ladder. He had remained asymptomatic throughout the years following surgery. Physical examination demonstrated complete loss of active thumb IP flexion. A flexor digitorum superficialis tendon to the ring finger (FDS-4) to the FPL tendon transfer was performed. The postoperative functional outcome after such a tendon transfer depends on factors such as surgical technique, tendon selection, and patient compliance with therapy, but it can often result in meaningful restoration of function. This case emphasizes the importance of long-term patient counseling regarding warning signs of hardware-related attritional tendon rupture, such as new-onset volar wrist pain, clicking, or sudden loss of thumb IP flexion, even years after fracture fixation. It also demonstrates that attritional FPL rupture following volar plate fixation may occur up to a decade postoperatively, requiring long-term patient counseling and continued clinical awareness for delayed tendon complications.