Excerpt from Hand, Tendon Lacerations: Extensors

Synonyms, Key Words, and Related Terms: extensor tendon injury, open injury, closed injury, mallet finger deformity, swan neck deformity, boutonnière deformity

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Do not regard extensor tendon lacerations as a "fitting challenge for the neophyte." The general principles and timing of management are similar to those pertaining to flexor tendon injuries. In combined repairs, flexor tendon rehabilitation must take priority. The mechanism of injury generally includes lacerations, crush injuries, avulsions, burns, and deep abrasions. Associated fractures are common with extensor injuries in the digits. In closed injury over the dorsum of the proximal interphalangeal joint, suspect extensor tendon injury. The criterion period for primary repair has been extended from the classic 6 hours to 12 hours if antibiotics are used.

The extensor tendon is extrasynovial except at the wrist level. Tendons are surrounded by paratenon for nourishment, supplying segmental arterial input. Interposition of scar between the tendon ends may result in the extensor tendon unit becoming too long, thus losing the ability to perform a useful function. Splinting extensor tendons even longer than the flexors is important to prevent damage to the repair by the more powerful flexor tendons. Although the extensor action is weaker than that of the flexors, the extensor mechanism is able to accommodate the full range of flexor tendon excursion by distal shift of the extensor expansion during digital flexion.

As in all hand surgery, meticulous handling of the tissues is vital. Scar formation can be demonstrated at every contact point along the tendon.

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