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Two-level Repair of the Extensor Indicis Proprius Transfer for Rupture of the Extensor Pollicis Longus

Sluijmer, Heleen C.E. BS; Neuhaus, Valentin MD; Mudgal, Chaitanya S. MD

doi: 10.1097/BTO.0000000000000057
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A single-level extensor indicis proprius (EIP) transfer to the extensor pollicis longus (EPL) is most commonly recommended for EPL rupture after distal radius fracture. We describe the technique and outcomes of a 2-level repair with EIP transfer to EPL. Five patients underwent repair by a single surgeon between 2006 and 2012. The difference between this repair and the previously mentioned standard technique is that besides the Pulvertaft weave done distally, the proximal end of the distal part of the ruptured EPL tendon and the EIP are additionally repaired with the help of a horizontal mattress suture in a side-to-side repair to get a 2-level repair to maximize strength of the EIP transfer. The 2-level repair with EIP transfer resulted in good functional outcomes for EPL rupture after distal radius fracture without complications. A 2-level repair seems to safely allow earlier commencement of rehabilitation and rapid recovery of function.

Orthopaedic Hand Service, Yawkey Center, Massachusetts General Hospital, Boston, MA

The authors declare that they have nothing to disclose.

Address correspondence and reprint requests to Chaitanya S. Mudgal, MD, Orthopaedic Hand Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail:

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