Closed Rupture of the Extensor Tendon of the Ring and Little Fingers Following Plate Fixation for Distal Ulna Fracture: A Case Report

Extensor tendon rupture following plate fixation for distal ulna fractures is extremely rare. We present a case of delayed closed rupture of the extensor tendons of the ring and little fingers following distal ulna plate fixation. A 71-year-old woman developed progressive swelling and loss of active extension of the ring and little fingers eight years after surgery for distal radius and ulna fractures. Computed tomography demonstrated dorsal penetration of the most distal ulnar screw. Surgical exploration confirmed rupture of the extensor digitorum communis tendons to the ring and little fingers and the extensor digiti minimi tendon. Screw removal and end-to-side tendon transfer were performed, resulting in satisfactory functional recovery without rerupture. This case suggests that dorsal screw prominence in distal ulna plating may contribute to delayed attritional extensor tendon rupture. Surgeons should carefully assess screw length intraoperatively and consider early implant removal when tendon irritation is suspected.