J Wrist Surg 2020; 09(04): 357-361
DOI: 10.1055/s-0040-1701513
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Bruno E. Crepaldi
1  Jeff Ecker Clinic, Bethesda Hospital, Claremont, Western Australia, Australia
,
1  Jeff Ecker Clinic, Bethesda Hospital, Claremont, Western Australia, Australia
,
Jeff Ecker
1  Jeff Ecker Clinic, Bethesda Hospital, Claremont, Western Australia, Australia
2  Health Sciences Department, Curtin University, Bentley, Western Australia, Australia
3  Hand and Upper Limb Centre, Claremont, Western Australia, Australia
› Author Affiliations
Further Information

Publication History

22 October 2019

20 December 2019

Publication Date:
19 February 2020 (online)

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.