Extensor Tendon Repair

Because of their location on the dorsum of the hand, the extensor tendons are particularly vulnerable to injury. This is even more likely over the joints since the dorsal skin is particularly thin there. Injuries can occur from both sharp and blunt trauma. Untreated extensor tendon injuries can result in significant functional impairment and potential long-term permanent deformities of the hand. There are significant differences in treatment for extensor tendon injuries involving the finger zones versus the hand. This chapter will describe the most common treatment modalities for extensor tendon injuries to the hand and forearm.

Dynamic Splinting After Extensor Tendon Repair in Zones V to VII

10.1016/s0266-7681(03)00014-7 ◽

2003 ◽

Vol 28 (3) ◽

pp. 224-227 ◽

Cited By ~ 35

Author(s):

S. BRÜNER ◽

M. WITTEMANN ◽

A. JESTER ◽

K. BLUMENTHAL ◽

G. GERMANN

Keyword(s):

Retrospective Study ◽

Surgical Complication ◽

Tendon Repair ◽

Extensor Tendon ◽

Tendon Injuries ◽

Active Motion ◽

Evaluation Systems ◽

Dynamic Splinting ◽

This retrospective study evaluates a dynamic active motion protocol for extensor tendon repairs in zones V to VII. Fifty-eight patients with 87 extensor tendon injuries were examined. Using Geldmacher’s and Kleinert and Verdan’s evaluation systems, the results were graded as “excellent” and “good” in more than 94%, and as “satisfactory” in the remainder. The need for secondary tenolysis was low (6%), and no other surgical complication occurred.

Management of Extensor Tendon Injuries

The Open Orthopaedics Journal ◽

10.2174/1874325001206010036 ◽

2012 ◽

Vol 6 (1) ◽

pp. 36-42 ◽

Cited By ~ 18

Author(s):

M Griffin ◽

S Hindocha ◽

D Jordan ◽

M Saleh ◽

W Khan

Keyword(s):

Subcutaneous Tissue ◽

Primary Repair ◽

Tendon Repair ◽

Extensor Tendon ◽

Tendon Injuries ◽

Lateral Instability ◽

Avulsion Fractures ◽

Post Surgery ◽

Human Bites ◽

Extensor tendon injuries are very common injuries, which inappropriately treated can cause severe lasting impairment for the patient. Assessment and management of flexor tendon injuries has been widely reviewed, unlike extensor injuries. It is clear from the literature that extensor tendon repair should be undertaken immediately but the exact approach depends on the extensor zone. Zone I injuries otherwise known as mallet injuries are often closed and treated with immobilisaton and conservative management where possible. Zone II injuries are again conservatively managed with splinting. Closed Zone III or ‘boutonniere’ injuries are managed conservatively unless there is evidence of displaced avulsion fractures at the base of the middle phalanx, axial and lateral instability of the PIPJ associated with loss of active or passive extension of the joint or failed non-operative treatment. Open zone III injuries are often treated surgically unless splinting enable the tendons to come together. Zone V injuries, are human bites until proven otherwise requires primary tendon repair after irrigation. Zone VI injuries are close to the thin paratendon and thin subcutaneous tissue which strong core type sutures and then splinting should be placed in extension for 4-6 weeks. Complete lacerations to zone IV and VII involve surgical primary repair followed by 6 weeks of splinting in extension. Zone VIII require multiple figure of eight sutures to repair the muscle bellies and static immobilisation of the wrist in 45 degrees of extension. To date there is little literature documenting the quality of repairing extensor tendon injuries however loss of flexion due to extensor tendon shortening, loss of flexion and extension resulting from adhesions and weakened grip can occur after surgery. This review aims to provide a systematic examination method for assessing extensor injuries, presentation and management of all type of extensor tendon injuries as well as guidance on mobilisation pre and post surgery.

Central slip extensor tendon injuries: a systematic review of treatments

10.1177/1753193419845311 ◽

2019 ◽

Vol 44 (8) ◽

pp. 825-832

Author(s):

Luke Geoghegan ◽

Justin Conrad Rosen Wormald ◽

Raina Zarb Adami ◽

Jeremy N. Rodrigues

Keyword(s):

Systematic Review ◽

Treatment Strategies ◽

Extensor Tendon ◽

Operative Management ◽

Evidence Base ◽

Tendon Injuries ◽

Treatment Modalities ◽

Full Text Review ◽

Central Slip ◽

This systematic review describes and compares outcomes of operative and non-operative management of central slip extensor tendon injuries. A PRISMA-compliant methodology identified 3785 studies. Of these, 29 underwent full text review. No randomized controlled trials were identified. Nine studies evaluated treatment modalities specific to cohorts with acute central slip injuries in adults. A range of operative and non-operative elements of management was identified although no studies directly compared the two. Where aspects of rehabilitation were studied, this was always after surgery. The evidence base regarding treatment of central slip injury is limited and the roles of different treatment strategies for open as well as closed injuries are not well-supported by evidence.

Results of Dynamic Splintage Following Extensor Tendon Repair

10.1016/s0266-7681(97)80084-8 ◽

1997 ◽

Vol 22 (2) ◽

pp. 283-287 ◽

Cited By ~ 41

Author(s):

W. Y. IP ◽

S. P. CHOW

Keyword(s):

Prospective Study ◽

Evaluation System ◽

Tendon Repair ◽

Extensor Tendon ◽

Tendon Injuries ◽

Power Grip ◽

Satisfactory Method ◽

A Prospective Study ◽

We report a prospective study of dynamic splintage following extensor tendon repair. Eighty-four patients with 101 extensor tendon injuries were studied. Using Dargan’s evaluation system, there were 97% excellent results for the thumb and 93% excellent and good results for the fingers. The average total active motions were 107° for thumbs and 245° for fingers. Over 80% of patients regained good power grip. Patients with associated digital fractures or with ragged lacerations had poorer results. Overall, we found that dynamic splintage was a satisfactory method after extensor repair.

Static Splinting of Extensor Tendon Repairs

10.1054/jhsb.1999.0346 ◽

2000 ◽

Vol 25 (2) ◽

pp. 180-182 ◽

Cited By ~ 41

Author(s):

T. PURCELL ◽

P. A. EADIE ◽

S. MURUGAN ◽

M. O’DONNELL ◽

M. LAWLESS

Keyword(s):

Tendon Repair ◽

Extensor Tendon ◽

Tendon Injuries ◽

Safe Method ◽

In a prospective review we assessed the results of extensor tendon injuries managed postoperatively with a static splint. Thirty-three patients with 44 injured digits were assessed 4 months after primary tendon repair, using the Strickland-Glogovac criteria. Patients were managed in a static splint, the duration of which was guided by the zone of injury. Four months after repair, excellent or good results were obtained in 95%. Overall it was found that static splinting was an effective and safe method of management after extensor tendon repair.

Early Active Mobilization for Extensor Tendon Injuries

10.1016/s0266-7681(97)80353-1 ◽

1997 ◽

Vol 22 (5) ◽

pp. 594-596 ◽

Cited By ~ 48

Author(s):

P. SYLAIDIS ◽

M. YOUATT ◽

A. LOGAN

Keyword(s):

Prospective Study ◽

Tendon Repair ◽

Extensor Tendon ◽

Tendon Injuries ◽

Good Function ◽

Dynamic Splinting ◽

Active Mobilization ◽

Extensor Tendon Injuries ◽

Complex Injuries

Dynamic splinting following extensor tendon repair gives better results than static splinting, but involves cumbersome splints and recommended protocols are often complicated. We prefer controlled active mobilization of extensor tendon repairs without dynamic splinting. Six weeks after repair, excellent or good function was obtained in 22 out of 24 simple extensor tendon injuries and in 11 out of 13 complex injuries. The results of this prospective study are comparable with those reported after dynamic splinting; this regime does not require outrigger splintage and is simple to follow.

Running Interlocking Horizontal Mattress—A New Technique versus Modified Kessler in Extensor Tendon Injuries: A Comparative Study

Journal of Hand and Microsurgery ◽

10.1055/s-0041-1727297 ◽

2021 ◽

Author(s):

Rohit Shaju ◽

Sunil Sharma ◽

Kshiteej Dhull

Keyword(s):

Tendon Repair ◽

Early Mobilization ◽

Extensor Tendon ◽

Tendon Injuries ◽

New Technique ◽

Interventional Study ◽

Effective Technique ◽

Controlled Motion ◽

A New Technique ◽

Abstract Introduction Pursuit for a new technique, which could be placed on flat extensor tendons and strong enough to withstand the tension forces of early mobilization to prevent stiffness, started few decades ago. We evaluated the new technique of tendon repair using running interlocking horizontal mattress (RIHM) sutures followed by early controlled motion protocol in traumatic extensor tendon injuries and compared it to modified Kessler technique. Materials and Methods We conducted a prospective randomized interventional study of 18 months’ duration, with 30 patients. A total of 103 tendons were repaired, of which 58 were repaired using modified Kessler technique and 45 were repaired using RIHM technique. Postoperatively, patients underwent the early controlled motion protocol and the results were evaluated using the criteria of Miller. Results Majority of the patients had excellent results (53.3%) and 46.67% had good results in the RIHM group while most of the patients in modified Kessler group had only fair results (80%), and only 20% had good results while none had excellent results. Conclusion RIHM suture is an easy-to-learn and effective technique for tendon repair with comparable operative duration and with better overall result than modified Kessler technique.

Extensor Tendon Repair and Reconstruction

10.2310/ps.10036 ◽

2020 ◽

Author(s):

Kelly D. Ledbetter ◽

Jeffrey B. Friedrich

Keyword(s):

Tendon Repair ◽

Treatment Strategies ◽

Tendon Healing ◽

Extensor Tendon ◽

Operative Management ◽

Tendon Injuries ◽

Presenting Symptoms ◽

Acute Injuries ◽

And Function ◽

The purpose of this chapter is to review the anatomy and function of extensor tendons, the physiology of tendon healing, and general principles regarding common acute and chronic extensor tendon injuries. Acute injuries are classified according to the modified Verdan system and the presenting symptoms, physical exam findings, and treatment strategies are discussed by zone of injury. Common chronic extensor tendon injuries are discussed as they relate to the dorsal wrist's division into six discrete fibro-osseous compartments. Lastly, this chapter reviews the role of operative vs non-operative management as well as the use of immobilization vs early protective motion in the post-operative setting. This review contains 7 figures, 1 table and 37 references. Keywords: extensor, tendon, repair, reconstruction, rehabilitation, tendonopathy, surgery, splint

The Effect of early active Movement following Repair of Extensor Tendons in Zone IV using three different suture Techniques – A cadaveric Study

Handchirurgie · Mikrochirurgie · Plastische Chirurgie ◽

10.1055/a-1560-3346 ◽

2021 ◽

Vol 53 (05) ◽

pp. 475-481

Author(s):

Samir Ilgaroglu Zeynalov ◽

Abdulveli Ismailoglu ◽

Ural Verimli ◽

Anar Alakbarov ◽

Eren Cansü

Keyword(s):

Extensor Tendon ◽

Suture Technique ◽

Tendon Injuries ◽

Suture Techniques ◽

Active Movement ◽

Gap Formation ◽

Extensor Tendons ◽

Extensor Tendon Injuries ◽

Hand Scale ◽

Flexion And Extension

Abstract Purpose The aim of this study was to investigate the effects of early active movement on the area repaired with three different suture techniques used in extensor tendon injuries in zone IV. Materials and Methods A total of nine cadaver’s 35 extensor tendons from 9 intact upper extremities were used in this study. The proximal and distal borders of the extensor tendons in zone IV were marked. The distance between the proximal and distal border was measured with a 0.5 mm precision tape measure and the mid-point was marked. Intertendinous connections were dissected and loop sutures were prepared for each extensor digitorum. Afterwards, force was applied to each digit along the tendon axis from the loops inserted into the extensor tendons, to measure the extensor forces required to extend the MCP joints to 0˚ with a hand scale. The flexor tendons of the digits were dissected at zone III, and loop sutures were prepared individually for the tendons to enable independent flexion for each digit. The force required to fully flex the digits was measured with a hand scale. The extensor tendons were incised transversely and repaired at the mid-point in zone IV with three different suture techniques (double Kessler, double figure of eight, running interlocking horizontal mattress (RIHM)). The extenxor tendon lengths in zone IV were re-measured for all digits after suturing. The predetermined forces required for full flexion and extension of the digits were applied to the repaired digits. After force was applied 20 times to each tendon, the gap formation was checked. Totally 200 flexion and 200 extension movements were applied to each finger with the help of a hand-held scale. Formation of 2-mm gap was failure criteria. At the end of the movements the extent of the gaps was recorded. In the absence of insufficiency at the repair site, 50 additional flexion and extension movements with double the previously recorded forces were applied to the tendons. Results There was a significant shortening of the extensor tendons after repair independent from the used suture technique. No significant gap formation was detected in all three suture techniques. Conclusion All three suturing techniques are reliable for early active movements following the zone IV extensor tendon repairs. Therefore, surgeons can choose one of those three suture techniques to repair extensor tendon injuries in zone IV.

A Comparison of Dynamic Extension Splinting and Controlled Active Mobilization of Complete Divisions of Extensor Tendons in Zones 5 and 6

10.1054/jhsb.1999.0356 ◽

2000 ◽

Vol 25 (2) ◽

pp. 140-146 ◽

Cited By ~ 49

Author(s):

A. R. KHANDWALA ◽

J. WEBB ◽

S. B. HARRIS ◽

A. J. FOSTER ◽

D. ELLIOT

Keyword(s):

Randomized Trial ◽

Statistical Difference ◽

Extensor Tendon ◽

Tendon Injuries ◽

Prospective Randomized Trial ◽

Extensor Tendons ◽

Active Mobilization ◽

We present a prospective randomized trial of two groups of 50 patients each having complete zone 5 and 6 extensor tendon injuries. These were rehabilitated by the use of either a dynamic outrigger splint or a palmar blocking splint. The results were analysed using the Miller and TAM assessments. Good and excellent results were achieved in 95 and 98% of cases following dynamic outrigger mobilization and 93 and 95% of cases using palmar blocking splint mobilization, using the Miller and TAM assessments respectively. There was no statistical difference in the results obtained between the two groups. Therefore, we prefer the latter technique which is simple, cheap, more convenient and requires less therapy time.