Extensor pollicis longus tendon rupture from Dorsal Nail Plate distal radius fixation with concomitant myostatic atrophy

Distal radius fractures are one of the most common upper extremity injuries seen by hand surgeons each year. Many of these fractures require reduction and surgical fixation because of displacement, comminution or inherent fracture instability. New hardware is designed and introduced each year to help surgeons manage these injuries. We report a case of a major complication from the use of the Dorsal Nail Plate hardware. The patient presented to our clinic with an extensor pollicis longus attrition rupture, which required tendon transfer for treatment. Intraoperatively, we also found ongoing extensor digitorum communis tendon attrition, myostatic atrophy of the extensor pollicus longus and ultimately a large bony defect following complex hardware removal. This case serves as a reminder to consider the potential complication profile of any hardware or technique you are considering using in your patients and to evaluate donor muscles and tendons when performing grafting or transfers.