Excision without Reconstruction of a Traumatically Ruptured Extensor Indicis Proprius Tendon in a Diabetic Patient: A Case Report.
Source: PubMed, NCBI / U.S. National Library of Medicine
Isolated traumatic rupture of the extensor indicis proprius (EIP) is uncommon and may be masked by preserved index finger extension through the intact extensor digitorum communis (EDC). While primary repair or tendon transfer is standard when reconstruction is feasible, the functional redundancy of the dual-extensor index finger raises the question of whether excision alone can suffice in selected cases. We report what we believe to be the first documented case of intentional EIP stump excision without reconstruction as definitive surgical treatment following delayed-presentation traumatic EIP rupture. A 45-year-old diabetic male metalworker (glycated hemoglobin 7.7%) sustained a dorsal wrist laceration from sheet metal. The patient self-managed initially but subsequently presented to the emergency department 2 weeks later. He was ultimately referred to our hand clinic 2 months post-injury with persistent dorsal hand pain, a palpable scar mass, and near-intact index finger extension. Magnetic resonance imaging (MRI) demonstrated tenosynovitis without reported rupture; our independent review identified sequential EIP disappearance on axial slices consistent with rupture. A diagnostic-therapeutic corticosteroid injection provided only a transient benefit. Surgical exploration revealed a fibrotic, retracted EIP stump with intact EDC tendons. The stump was excised without reconstruction. At 2-week follow-up, the patient reported no pain, demonstrated a full composite fist, intact
Abstract
Isolated traumatic rupture of the extensor indicis proprius (EIP) is uncommon and may be masked by preserved index finger extension through the intact extensor digitorum communis (EDC). While primary repair or tendon transfer is standard when reconstruction is feasible, the functional redundancy of the dual-extensor index finger raises the question of whether excision alone can suffice in selected cases. We report what we believe to be the first documented case of intentional EIP stump excision without reconstruction as definitive surgical treatment following delayed-presentation traumatic EIP rupture. A 45-year-old diabetic male metalworker (glycated hemoglobin 7.7%) sustained a dorsal wrist laceration from sheet metal. The patient self-managed initially but subsequently presented to the emergency department 2 weeks later. He was ultimately referred to our hand clinic 2 months post-injury with persistent dorsal hand pain, a palpable scar mass, and near-intact index finger extension. Magnetic resonance imaging (MRI) demonstrated tenosynovitis without reported rupture; our independent review identified sequential EIP disappearance on axial slices consistent with rupture. A diagnostic-therapeutic corticosteroid injection provided only a transient benefit. Surgical exploration revealed a fibrotic, retracted EIP stump with intact EDC tendons. The stump was excised without reconstruction. At 2-week follow-up, the patient reported no pain, demonstrated a full composite fist, intact distal sensation, and preserved index finger extension with a well-healing incision. EIP rupture may be underdiagnosed due to compensatory EDC extension and can be missed on MRI in the chronic fibrotic setting. In patients with preserved EDC function, significant comorbidities, and a non-viable chronic stump, excision without reconstruction eliminates a painful scar mass, reduces ongoing tenosynovitis, and avoids the morbidity of tendon transfer. Early functional results in this case are encouraging.