EPL Rupture

Aetiology

 

Undisplaced wrist fracture

- interrupts blood supply at a watershed area

- between 3 weeks and 3 months post injry

 

Spontaneous

- RA / SLE

 

Site

 

Just distal to extensor retinaculum at Lister's tubercle

 

Examination

 

Place hand flat on table

- lift only thumb

 

Management

 

Options

 

Direct repair

 

Often not possible

- poor tendon

- retracted

 

Palmaris longus graft

 

Extensor Indicis tendon transfer

 

IPJ fusion - RA

 

EI Transfer

 

Indications

- independently able to extend finger

- keep other fingers flexed, ask to extend IF
- indicates IE intact

 

Technique

 

Harvest

- incision at MCPJ

- EI is medial to EDC tendon

 

Reroute

- incision distal to extensor retinaculum

- incision at MCPJ thumb

- tunnel in straight line subcutaneously

 

Suture to EPL

- tension

- need to be able to obtain full flexion with wrist extended