COMPLEX RUPTURE OF THE EXTENSOR POLLICIS LONGUS TENDON FOLLOWING REPARATIVE OUTCOMES OF A DISTAL RADIAL METAPHYSEAL FRACTURE: A CASE REPORT

¹ Department of Radiology, Clinical Institute Città di Brescia, Brescia, Italy
² Oberdan Specialist Outpatient Clinic, Brescia, Italy
³ Orthopedic Service, Clinical Institute “Città di Brescia”, Brescia, Italy
⁴ Emergency Department Director, Ospedale di Gavardo, ASST del Garda, Gavardo, Italy

Correspondence to:

Journal of Orthopedics 2026 January-April; 18(1): 25-33
https://doi.org/10.69149/orthopedics/2026v18iss1_4

Received: 2 January 2026 Accepted: 30 January 2026

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Abstract

Distal radius fractures (DRFs) are among the most common injuries of the upper limb and, despite frequent conservative management, may evolve into unexpected outcomes, particularly when healing is irregular. Among late complications, rupture of the extensor pollicis longus (EPL) tendon is a rare but well-documented event, typically associated with post-traumatic deformities of Lister’s tubercle or chronic mechanical impingement. We report the case of a 59-year-old woman who sustained a sprain-type injury to the right wrist, initially treated conservatively after radiographic evidence of a mildly displaced distal metaphyseal fracture of the radius. During follow-up, despite immobilization, progressive loss of alignment was observed, with the development of a multifragmentary fracture pattern and formation of a prominent dorsal callus. Magnetic resonance imaging demonstrated irregular consolidation with a pointed deformity of Lister’s tubercle and, notably, a complete rupture of the EPL tendon with proximal retraction of the tendon stump. Additional findings included extensor tenosynovitis, minimal ulnar positive variance, and degenerative changes of the triangular fibrocartilage complex. This case highlights how a conservatively managed DRF may progress to late complications of bone remodeling. Post-traumatic deformation of Lister’s tubercle is a mechanical predisposing factor for EPL rupture, even several weeks after the initial injury. Advanced imaging, particularly magnetic resonance imaging, is essential in patients presenting with persistent pain or worsening functional impairment, as it enables the detection of subclinical abnormalities not visible on conventional radiographs. Delayed EPL rupture is an uncommon but clinically relevant complication of distal radius fractures with irregular healing. This case underscores the importance of careful follow-up, targeted use of advanced imaging, and timely management by hand surgery specialists. Adequate monitoring and early intervention may prevent unfavorable functional outcomes and guide appropriate therapeutic decision-making.

Keywords: case report, distal radius fracture, DRF, EPL rupture, Lister’s tubercle, MRI, tendon injury