Extensor indicis proprius tendon transfer for extensor pollicis longus rupture

The extensor pollicis longus (EPL) tendon is one of the most frequently ruptured tendons. The EPL is the primary extensor of the interphalangeal (IP) joint of the thumb and is also important in metacarpophalangeal (MCP) joint extension. The loss of this tendon leads to an inability to extend the thumb and raise it to the level of the palm, leaving the patient with a useless thumb (1). Clinically, the examiner can no longer palpate or see the upper boundary of the anatomical snuffbox. EPL tendon rupture was first mentioned by Duplay (2) in 1876. The etiology of EPL rupture is varied. Open injuries and lacerations to the tendon are a frequent cause of rupture. Distal radial fractures (displaced and nondisplaced) and rheumatoid arthritis are other frequent causes. Methods of reconstructing the tendon include direct repair, which is only possible if the laceration is recent, before myostatic contracture takes place, imposing a gap between disrupted tendon ends (3).