Attritional Carpal Dislocation and Flexor Tendon Rupture as a Rare Complication of Conservatively Managed Distal Radius Fracture in a Rheumatoid Patient

Distal radius malunions are known in rare instances to present a risk of tendon rupture. Rheumatoid arthritis and other inflammatory arthropathies also place patients at-risk of attritional tendon rupture as a sequelae of tendon degeneration from the underlying disease process. In this case report, we present a patient with psoriatic arthritis who sustained a distal radius fracture malunion after initially electing to pursue nonsurgical management, subsequently sustaining attritional dorsal carpal dislocation and ruptures of multiple flexor tendons 3 years after her initial injury resulting in considerable hand disability. She would then undergo wrist fusion and distal ulna resection with pending future staged flexor tendon reconstruction. Given the poor outcomes associated with multiple flexor tendon attritional ruptures, this case represents a cautionary example of the risks associated with nonsurgical management of distal radius fractures in patients with inflammatory arthropathies.