Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2025; 13(4): 100651
Published online Feb 6, 2025. doi: 10.12998/wjcc.v13.i4.100651
Brachioradialis tendon transfer and palmaris longus tendon graft for thumb avulsion: A case report and review of literature
Pierre Curings, Sonia Ramos-Pascual, Kinga Michalewska, Nicolas Gibert, Lionel Erhard, Mo Saffarini, Alexis Nogier
Pierre Curings, Department of Hand Surgery, Clinique Trenel, Sainte-Colombe 69560, France
Sonia Ramos-Pascual, Kinga Michalewska, Mo Saffarini, Medical Research, ReSurg SA, Nyon 1260, Vaud, Switzerland
Nicolas Gibert, Lionel Erhard, Department of Hand Surgery, Hand and Upper Limb Surgical Institute, Villeurbanne 69100, France
Alexis Nogier, Department of Orthopaedics, Clinique Trenel, Sainte-Colombe 69560, France
Author contributions: Curings P, Gibert N, and Erhard L designed the study; Curings P performed the research; Ramos-Pascual S and Michalewska K analysed the data and wrote the manuscript; Nogier A, Saffarini M, Gibert N, and Erhard L reviewed the manuscript; Ramos-Pascual S, Michalewska K, and Saffarini M edited the manuscript; and all authors have read and approved the final manuscript.
Informed consent statement: The patient provided informed consent for the use of his data and images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kinga Michalewska, MD, Medical Research, ReSurg SA, No. 22 Rue Saint-Jean, Nyon 1260, Vaud, Switzerland. journals@resurg.com
Received: August 22, 2024
Revised: October 12, 2024
Accepted: November 1, 2024
Published online: February 6, 2025
Processing time: 84 Days and 15.8 Hours
Abstract
BACKGROUND

Thumb replantation following complete traumatic avulsion requires complex techniques to restore function, especially in cases of avulsion at the level of the metacarpophalangeal joint (MCP I) and avulsion of the flexor pollicis longus (FPL) at the musculotendinous junction. Possible treatments include direct tendon suture or tendon transfer, most commonly from the ring finger. To optimize function and avoid donor finger complications, we performed thumb replantation with flexion restoration using brachioradialis (BR) tendon transfer with palmaris longus (PL) tendon graft.

CASE SUMMARY

A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail. The patient presented with skin and bone avulsion at the MCP I, avulsion of the FPL tendon at the musculotendinous junction (zone 5), avulsion of the extensor pollicis longus tendon (zone T3), and avulsion of the thumb’s collateral arteries and nerves. The patient was treated with two stage thumb repair. The first intervention consisted of thumb replantation with MCP I arthrodesis, resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis. The second intervention consisted of PL tendon graft and BR tendon transfer. Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°, grip strength of 45 kg, key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.

CONCLUSION

Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.

Keywords: Brachioradialis tendon transfer; Flexor pollicis longus; Palmaris longus tendon graft; Replantation; Thumb amputation; Thumb avulsion; Case report

Core Tip: Complete traumatic amputation of the thumb, especially when the flexor pollicis longus is avulsed at the musculotendinous junction, requires a complex replantation technique in order to restore function. Possible treatments include direct tendon suture or tendon transfer, most commonly from the ring finger. To optimize functional outcomes and avoid donor finger complications, we propose a new surgical technique with brachioradialis tendon transfer and palmaris longus tendon graft. This technique was able to restore thumb flexion and provide good key pinch strength.