Flexor Pollicis Longus Rupture in a Scaphoid Nonunion: A Case Report

Abstract

Background Flexor pollicis longus (FPL) tendon rupture is a rare complication of scaphoid nonunion.

Case Description A fit active 70-year-old woman ruptured her FPL when it abraded on a painless 50-year-old scaphoid nonunion. She had asymptomatic scaphoid nonunion advanced collapse (SNAC) arthritis. At surgery, the sharp mobile volar scaphoid osteophytes were excised and the volar wrist capsule was repaired. A vascularized fat flap based on a perforator of the radial artery was used to augment the volar wrist capsule repair and to create a smooth gliding surface for the FPL. The ruptured FPL tendon was reconstructed with a palmaris longus graft.

Literature Review Complete rupture of the FPL tendon secondary to scaphoid nonunion is a rare complication. It can be easily misdiagnosed because the original injury may be unrecognized or forgotten. A consensus regarding the optimal surgical management has not been reached.

Clinical Relevance The objective of surgery in this case was to restore FPL function and prevent a recurrent rupture. The asymptomatic SNAC arthritis was not treated. No further wrist surgery was required. The patient was asymptomatic with a functioning FPL tendon 4 years after surgery.

Keywords

flexor pollicis longus - FPL rupture - scaphoid nonunion

• References

• 1 Mahring M, Semple C, Gray IC. Attritional flexor tendon rupture due to a scaphoid non union imitating an anterior interosseous nerve syndrome: a case report. J Hand Surg Br 1985; 10 (01) 62-64
• 2 Thomsen S, Falstie-Jensen S. Rupture of the flexor pollicis longus tendon associated with an ununited fracture of the scaphoid. J Hand Surg Am 1988; 13 (02) 220-222
• 3 McLain RF, Steyers CM. Tendon ruptures with scaphoid nonunion. A case report. Clin Orthop Relat Res 1990; (255) 117-120
• 4 Saitoh S, Hata Y, Murakami N, Nakatsuchi Y, Seki H, Takaoka K. Scaphoid nonunion and flexor pollicis longus tendon rupture. J Hand Surg Am 1999; 24 (06) 1211-1219
• 5 Pierrart J, Rétoré JY, Leclercq C. A rare complication of scaphoid nonunion: Multiple flexor tendon lesions. A case report and review of literature. Hand Surg Rehabil 2016; 35 (02) 135-138
• 6 Cross AB. Rupture of the flexor pollicis longus tendon resulting from the non-union of a scaphoid fracture. J Hand Surg Br 1988; 13 (01) 80-82
• 7 Wacker J, McKie S, MacLean JG. Delayed sequential ruptures of the index and thumb flexor tendons due to an occult scaphoid nonunion. J Hand Surg Br 1999; 24 (06) 741-743
• 8 Moritomo H, Murase T, Oka K, Tanaka H, Yoshikawa H, Sugamoto K. Relationship between the fracture location and the kinematic pattern in scaphoid nonunion. J Hand Surg Am 2008; 33 (09) 1459-1468