Purpose: Extensor pollicis longus (EPL) tendon ruptures may be associated with nondisplaced distal radius fractures. Theoretically, blood extravasation and fracture debris may fill the third dorsal compartment, resulting in increased pressure and constriction of the EPL tendon and leading to late attritional rupture. Beneath the extensor retinaculum is a watershed zone of intrinsic vascular supply to the EPL tendon in which ruptures commonly occur. Rupture also may result from the EPL tendon rubbing on a bony prominence or callus. This video demonstrates the procedure for transferring the extensor indices proprius tendon to the EPL tendon for the management of EPL tendon rupture.

Methods: This video discusses the case presentation of a 42-year-old man who was unable to properly move his left thumb. He stated that he was working in his yard and a piece of wood fell on his wrist. Approximately 3 months later, he felt a pop in his wrist and was unable to properly use his thumb. On physical examination, he had difficulty actively extending his left thumb interphalangeal joint; however, he had full passive range of motion. In addition, he was unable to move his left thumb posterior to the plane of his hand. Radiographs of his wrist revealed a dorsal prominence and callus formation. The video demonstrates the procedure for transferring the extensor indices proprius tendon to the EPL tendon.

Results: The patient's thumb was immobilized in a thumb spica splint (20° of wrist flexion and thumb interphalangeal joint at 0°) for 4 weeks postoperatively. The patient began active range of motion exercises after the splint was removed. At the end of the video, we demonstrate the patient’s improved function and ability to reposition his thumb and use a pair of scissors at 2 months postoperatively.

Conclusion: Extensor indices proprius tendon transfer for the management of EPL tendon rupture may afford patients improved function. Potential complications of this procedure include injury to the extensor digitorum communis and loss of independent index finger extension.