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