Delayed extensor pollicis longus tendon rupture after minimally displaced distal radius fracture: a report of two cases

Introduction: Extensor pollicis longus (EPL) tendon rupture is an uncommon but serious complication following nondisplaced or minimally displaced distal radius fractures. Case presentation: We present two cases of delayed EPL tendon rupture. A 61-year-old woman and a 41-year-old man both developed inability to extend the thumb several weeks after conservative treatment of minimally displaced distal radius fractures. Intraoperative findings revealed poor tendon quality and significant retraction. Both patients were managed with palmaris longus tendon graft using the Pulvertaft weave technique. Outcomes: At 10 months, PRWHE improved from 48 to 10, exceeding the ≈ 14-point MCID; Kapandji improved from 6 to 9 on the operated side and matched the contralateral hand. Conclusion: Rupture of the EPL tendon after minimally displaced distal radius fracture is a rare but clinically significant complication with major impact on hand function. Delayed EPL rupture may present 3-12 weeks after minimally displaced distal radius fractures; prompt recognition of progressive loss of active IP extension is essential. When direct repair is not feasible and stumps are available, palmaris longus intercalated grafting offers reliable recovery while preserving independent index extension.