PMC6231376_01
Radiographic presentation. Initial imaging on presentation to hand clinic after the patient was splinted at another facility.
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X-rays of the left wrist were taken through a splint applied the day before at another facility (Figure 1).
Initial fixation. Postoperative X-ray showing fixation with a 2.4/2.7 mm Synthes dorsal spanning plate and three K wires.
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Additional, percutaneously placed K wires offered additional stabilization of the radial styloid and lunate facet (Figure 2). Postoperative X-rays showed improved radial inclination and articular congruity, but residual slight dorsal tilt (Figure 2).
Return to clinic. X-rays on return to clinic, 12.5 months after dorsal bridge plate placement.
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X-rays showed that the dorsal bridge plate had broken at the level of the radiocarpal joint, through an empty screw hole (Figure 3).
Extensor tendon damage. Metallosis, fraying, and near-complete rupture of the EPL tendon, shown on top of the tenotomy scissors (a). Close-up view of the metallosis as well as the distal EI and ECRL tendon damage over the index metacarpal (b).
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Metallosis, severe attenuation, fraying, and a near-complete rupture of the EPL tendon was found at the same level the plate was broken (Figure 4(a)). We saw extensive metallosis and damaged-appearing extensor indices (EI) and distal extensor carpi radialis longus (ECRL) tendons over the index metacarpal (Figure 4(b)).
Damaged EPL and bridge plate. The excised portion of the frayed EPL tendon is photographed next to the broken dorsal spanning plate. This damaged portion of the EPL tendon was at the level of the broken plate in situ.
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We excised the damaged portion of the EPL tendon (Figure 5).
EPL reconstruction. We reconstructed the EPL tendon using an end-to-end tendon transfer from the ECRL.
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We transferred ECRL to the EPL in an end-to-end fashion after resecting the damaged, distal portion of the ECRL tendon (Figure 6).