Regarding a Simple and Quick Tendon Transfer Technique to Restore Thumb Function

Francisco Rodriguez-Fontan, MD*

1Department of Orthopedics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA 2Colorado Program for Musculoskeletal Research, Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA 3Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina

^*Correspondance to: Francisco Rodriguez-Fontan 

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Abstract:

I recently read with great interest the article titled “A Simple and Quick Tendon Transfer Technique to Restore Thumb Function” by Anindya Lahiri [1]. The idea of using one incision for Extensor Indicis Proprius (EIP) to Extensor Pollicis Longus (EPL) transfer procedure is brilliant as compared to the standard three incision technique described by Schneider and Rosenstein [2]. EPL rupture leads to loss of retropulsion and inability to fully extend the interphalangeal joint. The most common circumstance is a distal radius fracture treated either surgically or not, and its incidence varies from 1% to 5% of the cases. It can be associated to attrition from the fracture, hematoma compromising the vascular supply, or the irritation from the hardware [3]. Our concern to this surgical technique paper stems from the cause of the EPL rupture. In the setting of a non to minimally displaced distal radius fracture, the dorsal bone prominence or sharpness around Lister’s tubercle causes the tendon rupture. The same could potentially cause EIP rupture in the 4th extensor compartment. More significantly, if the EIP is not explored proximally and re-routed or the bone prominence is not addressed when performing the EIP to EPL transfer. Recent reports have documented on such scenarios where the EIP left in the 4th compartment led to attrition and rupture and recommend exploring the 4th compartment prior to the transfer [4,5]. A similar setting, though probably more technique related is when placing distal radius volar plates, which can lead to extensor tendon injury or irritation over time [5,6]. In our experience, at our institution when performing EIP to EPL transfer, we address this in a standard 3 incision approach. The EIP is identified in the 4th compartment by its characteristic distal muscle belly and deep position. The Extensor Digitorum Communis (EDC) of the index finger is also assessed. The EIP is retrieved and made extra-compartmental and subcutaneous to avoid possible attrition. How comfortable does the author feel about leaving the proximal aspect of EIP unaddressed or unexplored? Have there been any EIP or EDC complications in such circumstances? We would be glad if the authors could share their experience or point of view.

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Cite the Article:

Rodriguez-Fontan F. Regarding a Simple and Quick Tendon Transfer Technique to Restore Thumb Function. World J Surg Surgical Res. 2022; 5: 1360.