Tendon Transfer Versus Tendon Graft Reconstruction of Flexor Pollicis Longus Attritional Ruptures Secondary to Volar Plating of Distal Radius Fractures.

Publication/Presentation Date

4-9-2026

Abstract

BACKGROUND: Attritional rupture of the flexor pollicis longus (FPL) after volar plating of distal radius fractures is an uncommon but morbid complication, secondary to plate prominence at or distal to the watershed zone. No consensus exists regarding the optimal reconstruction, as both tendon grafting and tendon transfer are routinely utilized. This study evaluated clinical outcomes of tendon transfer versus tendon grafting for FPL rupture following volar plate fixation and compared presenting features, radiographic prominence, and complications between cohorts.

METHODS: A retrospective review identified 38 reconstructions in 37 patients (2010-2024) following FPL rupture after volar plating. Demographics, plate prominence, timing, presentation, and outcomes were analyzed using Mann-Whitney U, chi-square, or Fisher's exact tests.

RESULTS: Twenty-five tendon grafts (21 palmaris longus, 2 flexor carpi radialis, 1 allograft, 1 index flexor digitorum superficialis [FDS]) and 13 tendon transfers (12 ring FDS, 1 long FDS) were performed. Groups were demographically comparable. Volar wrist pain at presentation was less frequent in tendon transfer (23%) versus graft (48%). The rupture-to-reconstruction interval was shorter for grafts (median 40 vs 72 days;

CONCLUSIONS: Both tendon grafting and tendon transfer restore thumb flexion with comparable complication rates. Chronic rupture, poor proximal FPL quality, or limited excursion may favor tendon transfer. Prophylactic hardware removal in at-risk patients remains prudent.

First Page

15589447261430937

Last Page

15589447261430937

ISSN

1558-9455

Disciplines

Education | Medical Education

PubMedID

41956824

Department(s)

Department of Education

Document Type

Article

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