Delayed rupture of extensor indicis proprius (EIP) and extensor pollicis longus (EPL) following volar plating of distal radius fracture: A case report

Distal radius fractures are the most common upper limb fractures, with volar plating being the preferred surgical approach, particularly for intra-articular and unstable fractures. While complications primarily involve flexor tendon irritation or rupture, extensor tendon injuries associated with volar plating are rare. This report discusses a 23-year-old male who experienced limited active range of motion (ROM) in the thumb and index finger of his right hand 2 years after volar plating for a distal radius fracture. Imaging studies, including radiography and MRI, confirmed satisfactory fracture healing. However, 2 screws were found protruding beyond the dorsal cortex of the distal radius. One screw extended over the Lister's tubercle, and another occupied the fourth compartment of the wrist. MRI also revealed the absence of the extensor indicis proprius (EIP) and extensor pollicis longus (EPL) tendons at the wrist level, suggesting tendon rupture. The plate and screws were removed via a palmar approach, and a 2-stage tendon graft procedure was performed to restore function. At the 1-year follow-up, the patient demonstrated excellent functional recovery, with no deficits in extending the thumb and index finger. This case highlights the risk of delayed multirupture of extensor tendons following volar plating of distal radius fractures, even after prolonged intervals postsurgery. Such complications, though rare, necessitate early recognition and management to prevent long-term functional impairments. Orthopedic and hand surgeons should consider this possibility during follow-ups and take preventive measures, such as ensuring screw lengths do not exceed the dorsal cortex during the initial procedure. By presenting this case, we aim to raise awareness of this potential complication and provide insights into its diagnosis, management, and prevention.