Extensor Tendon Lacerations Research Articles

Effectiveness of a novel finger range-of-motion brace for extensor tendon injury: a report of 10 patients

BackgroundExtensor tendon injuries require surgical repair, followed by rehabilitation to ensure optimal outcomes. Immobilization has been the cornerstone of postoperative management. However, immobilization after surgery frequently makes the finger stiffness, often resulting in reduced functionality and quality of life for patients. Recent studies indicate that early controlled motion can significantly improve outcomes, but safe early range of motion (ROM) exercise is a significant clinical challenge. This article aims to check the efficacy of the novel designed finger ROM brace for preventing finger stiffness for extensor tendon injuries with case series.MethodsA finger ROM brace was designed based on the natural finger movement. Like a real finger, there are two tiny hinge joints and three round-shape body components. The design aimed to be ergonomic dynamic splint assisting controlled motion to promote early motion, thus reducing tendon tension and preventing stiffness. Elastic resistant ROM exercise could be by inserting a silicone band into the groove on the components and free movement could be achieved by removing a silicone band.ResultBetween December 2022 and July 2023, 10 patients who underwent tenorrhaphy because of extensor tendon laceration were involved. Complete extensor tendon laceration was 3 patients, other seven patients had partial laceration of extensor tendons. Surgery was performed within 2 days of injury, and no infection was observed in all patients. After the extensor tendon was confirmed as healed state by ultrasound, the patients were permit the active exercise wearing finger ROM brace with a silicone band. Within 1–2 weeks after elastic resistant exercise, the patients could achieve free full ROM movement without any complication.ConclusionThe novel finger ROM brace combines the advantages of dynamic splinting and under-actuated mechanisms to offer a comprehensive solution for preventing stiffness after extensor tendon suture. Future studies should focus on clinical trials to validate the efficacy and safety of this brace in a larger population.

Extensor Tendon Repair.

Extensor tendon injuries are a common condition that hand surgeons must be prepared to treat. The area of extensor tendon injury can traditionally be broken down into 9 zones. Physical examination is the best way to diagnose extensor tendon injury with a loss of active extension in the injured digit. The tenodesis effect may be utilized to aid in diagnosis: wrist flexion should cause passive extension at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints if the extensor tendon is in continuity. Repair of extensor tendon injuries depends on the zone of injury and the thickness of the tendon, which determines its ability to hold core sutures. For zone-I and II injuries, several "figure of 8" buried sutures can be utilized or a running type of suture may be employed. For zone-III to VII injuries, 1 or 2 core sutures and a supplementary running suture can be utilized. Several alternative techniques have been previously described. These include variations in the number of core strands, repair configuration, and suture caliber, as well as the use of epitendinous repair. Alternative treatments also include nonoperative treatment, which is typically reserved for partial tendon injuries and for patients who are unable to tolerate a surgical procedure. The techniques that we describe are tailored to the thickness of the tendon. Running sutures are applicable to any zone, whereas core sutures are best utilized in zones III through VII. The running interlocking horizontal mattress technique has been found to be stiffer and faster to accomplish compared with the other techniques, and was found to have good to excellent clinical results in a study of lacerations in zones IV and V1,2. Repair of extensor tendon lacerations has demonstrated good long-term outcomes if performed in a timely manner after injury. A previous study showed good to excellent function in up to 64% of acute extensor tendon repairs, more fingers lost the ability to flex fully than lost the ability to extend3. Systematic reviews have suggested that dynamic rehabilitation may not provide superior long-term benefit compared with static splinting4. The Elson test should be performed under a digital nerve block in order to properly assess the integrity of the central slip.In distal zone I and III injuries, suture anchors or bone tunnels may be utilized when there is no remaining tendon on the distal end of the laceration.When preparing the tendon ends for repair, it is important to handle the tendon delicately-preferably through the cut end of the tendon rather than the tendon itself.In zone-VII injuries, the injured tendon may lie beneath the extensor retinaculum. In such cases, windowing of the extensor retinaculum may decrease adhesion formation and facilitate repair. MCP = metacarpophalangealPIP = proximal interphalangealDIP = distal interphalangealIP = interphalangealROM = range of motionRMS = relative motion splintRIHM = running interlocking horizontal mattress.

Evaluation Of Clinical And Cost Analysis Of Patients Applying To The Emergency Service With Extensor Tendon Incision In The Upper Extremity

ABSTRACT Bacground/Aims: Hand trauma is common in emergency departments, with approximately 20% of regional traumas involving hand injuries. Extensor tendon lacerations, often caused by sharp objects, are frequently encountered but may be overlooked, leading to significant morbidity. This study aims to retrospectively review cases of extensor tendon lacerations in the upper extremities to highlight the importance of thorough evaluation and management in the emergency department. Methods: A single-center retrospective study included 114 patients presenting to the emergency department with extensor tendon lacerations. Data on patient demographics, injury characteristics, treatment, complications, and costs were collected and analyzed. Statistical analysis was performed using SPSS version 26.0. Results: The majority of patients were male adults, with sharp objects such as knives being the most common cause of injury. Extensor tendon repairs were predominantly performed in the emergency department, with complications observed in 14.9% of cases. The mean cost of treatment was $255.97. Factors influencing the decision to perform repair in the operating room included patient age, injury characteristics, and associated injuries. Conclusions: Extensor tendon lacerations in the upper extremities represent a significant burden in emergency departments. Our findings emphasize the importance of thorough evaluation and timely management to prevent missed diagnoses and optimize patient outcomes. Repairing extensor tendon injuries in the emergency department can be cost-effective and efficient, but careful consideration of patient and injury factors is necessary to determine the most appropriate treatment setting.

An Improvised Approach to Relative Motion Extension Splinting in the Emergency Room.

Summary:Lacerations to the dorsum of the hand are frequently complicated by involvement of extensor tendons. Bedside repair of these injuries in the emergency room decreases time to treatment and avoids operating room expenses and anesthetic associated risks. Optimal outcomes require prompt follow-up and initiation of hand therapy to promote tendon gliding and prevent tethering of scar tissue. Here, we present our improvised relative motion extension splint utilized in treatment of zone five and six extensor tendon lacerations. This orthosis is preferred in isolated extensor tendon injuries that are amenable to primary repair at the bedside in the appropriately compliant and motivated patient. Our design is comprised of readily available supplies in the emergency room setting. Our improvised relative motion extension splint is lighter weight versus a traditional plaster orthosis and frees the patient to engage in activities of daily living with the injured hand on day four following tendon repair. With repeated application we have become facile with this design, which also permits flexibility such as placement of a wrist extension splint component if needed. Relative motion extension splinting is an established method of treatment following extensor tendon repair. Here, we present a straightforward method of fabricating such a device in the emergency room without the availability of thermoplastic materials. Future study will be needed to establish the efficacy of this device versus its thermoplastic counterpart.

The Economic Impact of Extensor Tendon Lacerations of the Hand in the United States.

Extensor tendon lacerations (ETLs) are a common and debilitating injury for thousands of Americans annually. No study has attempted to estimate their economic impact. The objective of this study was to estimate the economic impact of ETLs in America. The cost of ETLs to society was estimated using a validated prevalence-based cost of illness model. The primary cohort was defined as all patients with complete ETLs in the United States undergoing surgical repair and, secondarily, the imputed number of patients requiring reoperation within 1 year. For these groups, both direct and indirect costs (lost income, missed workdays, and disability payments) were measured. The total annual direct medical costs amounted to $14,095.28 per injury and 100,000 population. The total annual indirect labor costs were found to range between $80,842.90 and $150,136.82 per injury and 100,000 population. Hence, the estimated total costs of ETLs are $307 million per year in the United States alone and could be as high as $531 million annually depending on the effects of worker absenteeism on the core production-based industries. Extensor tendon lacerations incur a significant economic burden to our health care system and are more costly when compared with many other common hand conditions. Specifically, indirect costs are the major contributor toward the total cost these injuries incur on society, accounting for an upward of 91% of the total cost. These results suggest efforts be focused on improving rehabilitation protocols and treatments. Level II-economic and decision analyses.

Recent Developments Are Changing Extensor Tendon Management.

After reviewing this article, the participant should be able to: Start early protected movement at 3 to 5 days after surgery with relative motion extension splinting for zone 5 extensor tendon lacerations over the hand. Allow patients to resume regular activities much sooner than the conventional 3 to 4 weeks of splinting after extensor tendon repair. Improve the rehabilitation of boutonniere deformities with relative motion splinting. This article focuses on surgery and rehabilitation of extensor tendon injuries from the proximal interphalangeal joint (boutonniere) to the wrist. Relative motion flexion and extension splinting and wide awake, local anesthesia, no tourniquet surgery have revolutionized the management of these lesions, with early protected movement, sooner return to regular activities, and improved rehabilitation. This article explains and illustrates these new advances in extensor tendon management.

Case Study: Novel Application of Modified Duran Rehabilitation Protocol in Foot Extensor Tendon Laceration Repair

Surgical repair of traumatic extensor tendon lacerations in the leg are not commonly encountered and can present with a wide variety of functional deficits. Investigation of current literature did not yield prior documentation of this type of injury or surgical repair. The purpose of this poster is to present the surgical repair and rehabilitation of Extensor Digitorum Longus (EDL) tendons using a novel application of the Modified Duran Protocol in a young healthy adult female.

Biomechanical Study of Extensor Tendon Lacerations Over the Finger Metacarpophalangeal Joints

Purpose To assess the percentages of extensor tendon lacerations over the finger metacarpophalangeal (MCP) joints that may lead to an MCP joint extensor lag. Methods We obtained 8t fresh-frozen cadaveric hand specimens. The extensor and flexor tendons were isolated for simulated active extension and passive flexion. The specimens were secured to a testing jig. Sequential full-thickness, transverse cuts were made through the extensor tendons over each MCP joint. The fingers were cycled before and after each incremental tendon cut. Extensor tendon gaps were measured and inclinometer measurements of MCP joint rotation were used to determine MCP joint extensor lags. Results Incremental cuts of the extensor tendons caused sequential increases in subjacent MCP joint extensor lags in addition to interactive effects on other finger MCP joints. Extensor lags of the index and little finger MCP joints were statistically significant; lacerations extended across 75% or more of the combined widths of the extensor tendon slips. In comparison, extensor lags of the middle and ring finger MCP joints were statistically significant; lacerations involved 90% or more of the widths of the extensor tendons. A statistically significant MCP joint extensor lag in the index and little fingers was also observed when 1 of 2 extensor tendon slips in either finger was completely transected. Conclusions In this biomechanical study of extensor tendon lacerations over the finger MCP joints, we found that MCP joint extensor lags varied by both the finger involved and the percentage of tendon width damage. Additional work is needed to determine the clinical importance of MCP joint extensor lags of differing degrees. Clinical relevance Lacerations of extensor tendons overlying the finger MCP joints in clenched-fist to mouth injuries are typically repaired in a delayed fashion. An improved understanding of the relations between extensor tendon slip lacerations and MCP joint extensor lags may provide a basis for treatment algorithms that could potentially reduce the costs of care.

Graft of Small Patch of Partial Thickness in Equine Wound

Background: Cutaneous wounds in locomotor limbs represent one of the most frequent disorders in equine medicine. Wounds in equines are distinguished from those in other species by unique characteristics, including different healing rates among breeds, wound location and high propensity to formation of exuberant granulation tissue during the healing process. The wound healing process that cannot be sutured can be accelerated by the use of skin grafts, lowering the treatment cost.The objective of this report was to divulgate the success upon treatment of an extensive lacerated wound in the metatarsal region of a horse using autologous skin grafts.Case: A 3-year-old, female, American quarter horse weighting 450 kg was brought to veterinary hospital with lower limb injury. According to the owner’s report, the animal had one of its limbs stuck in a plain wire fence. A wound was observed in the metatarsal region during physical examination, the lesion caused an extensive skin laceration that showed the dorsal surface of the metatarsal bone and the digital extensor tendon. After injury assessment, wound debridement was carried out by surgery intervention followed by antisepsis and application of autologous plasma every two days as post-surgical care and wound preparation to receive the graft. Forty-five days after the first intervention, grafts were collected from the neck and implanted in the wound. The procedure achieved 70% of success. After approximately 75 days, transplantation was performed in other regions of the wound using the same technique. The duration of treatment at the Veterinary Hospital of the Universidade Paranaense (UNIPAR) was eight months, and then the animal returned home, where dressings were applied for two months to avoid the risk of contamination and until complete recovery.Discussion: The debridement of the wound and edges approximation were of great value in order to begin the process of wound granulation. The established therapy with scarring with gauze and use of antiseptics only in the initial stages of treatment, the frequent exchange of bandages every two days, preventing the accumulation of exudate and the use of autologous plasma favored the formation of the granulation bed and was sufficient to avoid infection and the formation of exuberant granulation tissue. Factors such as excessive movement and local infection were also attributed as responsible for the longer healing period, so the use of the spring coupled to the horseshoe decreased the joint movement, proving tobe effective in patients with severe extensor tendon lacerations. The use of the spring coupled to the horseshoe promoted a correct biomechanical alignment and no walking complication or deficiency was observed. The correct anatomical structural positioning prevents the formation of flexural deformities and fibrosis of the joint capsule. The use of micrografts wasbeneficial and simple to perform and the use of grafts contributed to a better cosmetic result. The main factor contributed to the grafting success was the use of dressing, which was regularly changed, and topical antimicrobial therapy correctly applied to avoid contamination. Based on the clinical result of this patient, it was concluded that the use of small autologous grafts can provide good recovery and healing of extensive wounds in horses when proper care with dressings and antimicrobial medication is provided after surgical interventions.Keywords: equine, surgery, graft, healing.

Accuracy of High-Resolution Ultrasonography in the Detection of Extensor Tendon Lacerations.

Lacerations to the extensor mechanism are usually diagnosed clinically. Ultrasound (US) has been a growing diagnostic tool for tendon injuries since the 1990s. To date, there has been no publication establishing the accuracy and reliability of US in the evaluation of extensor mechanism lacerations in the hand. The purpose of this study is to determine the accuracy of US to detect extensor tendon injuries in the hand. Sixteen fingers and 4 thumbs in 4 fresh-frozen and thawed cadaveric hands were used. Sixty-eight 0.5-cm transverse skin lacerations were created. Twenty-seven extensor tendons were sharply transected. The remaining skin lacerations were used as sham dissection controls. One US technologist and one fellowship-trained musculoskeletal radiologist performed real-time dynamic US studies in and out of water bath. A second fellowship trained musculoskeletal radiologist subsequently reviewed the static US images. Dynamic and static US interpretation accuracy was assessed using dissection as "truth." All 27 extensor tendon lacerations and controls were identified correctly with dynamic imaging as either injury models that had a transected extensor tendon or sham controls with intact extensor tendons (sensitivity = 100%, specificity = 100%, positive predictive value = 1.0; all significantly greater than chance). Static imaging had a sensitivity of 85%, specificity of 89%, and accuracy of 88% (all significantly greater than chance). The results of the dynamic real time versus static US imaging were clearly different but did not reach statistical significance. Diagnostic US is a very accurate noninvasive study that can identify extensor mechanism injuries. Clinically suspected cases of acute extensor tendon injury scanned by high-frequency US can aid and/or confirm the diagnosis, with dynamic imaging providing added value compared to static. Ultrasonography, to aid in the diagnosis of extensor mechanism lacerations, can be successfully used in a reliable and accurate manner.

Relative active motion programs following extensor tendon repair: A pilot study using a prospective cohort and evaluating outcomes following orthotic interventions

Study designProspective cohort. IntroductionThe Immediate Controlled Active Motion program, used to manage extensor tendon repairs in the hand, immobilizes the wrist in an orthosis with the affected finger(s) placed in a separate yoke orthosis allowing controlled flexion. PurposeTo compare our outcomes using similar programs in patients with simple extensor tendon lacerations to those previously reported. To compare our 4-week orthotic intervention to our 6-week orthotic intervention. Methods18 subjects received a 4-week orthotic intervention, 45 subjects received a 6-week orthotic intervention. Range of motion was measured 4, 6 and 8 weeks post-repair, grip strength at 6 and 8 weeks, and patient-rated outcomes at baseline, 6 and 12 weeks post-repair. ResultsSignificant improvements in all outcomes were seen over time (p < 0.0001), with no significant differences between programs. ConclusionOutcomes were comparable with those previously published and similar between the 4-week and 6-week orthotic interventions. Level of evidenceIII

Outcomes of Digital Zone IV and V and Thumb Zone TI to TIV Extensor Tendon Repairs Using a Running Interlocking Horizontal Mattress Technique

Biomechanical evidence has demonstrated that the running interlocking horizontal mattress (RIHM) repair for extensor tendon lacerations is significantly stronger, with higher ultimate load to failure and less tendon shortening compared with other techniques. We investigated the efficacy and safety of primary extensor tendon repair using the RIHM repair technique in the fingers followed by the immediate controlled active motion protocol, and in the thumb followed by a dynamic extension protocol. We conducted a retrospective review of all patients undergoing extensor tendon repair from August 2009 to April 2012 by single surgeon in an academic hand surgery practice. The inclusion criteria were simple extensor tendon lacerations in digital zones IV and V and thumb zones TI to TIV and primary repair performed using the RIHM technique. We included 8 consecutive patients with 9 tendon lacerations (3 in the thumb). One patient underwent a concomitant dorsal hand rotation flap for soft tissue coverage. We used a 3-0 nonabsorbable braided suture to perform a running simple suture in 1 direction to obtain a tension-free tenorrhaphy, followed by an RIHM corset-type suture using the same continuous strand in the opposite direction. Average time to surgery was 10 days (range, 3-33 d). Mean follow-up was 15 weeks (range, 10-26 wk). We applied the immediate controlled active motion protocol to all injuries except those in the thumb, where we used a dynamic extension protocol instead. Using the criteria of Miller, all 9 tendon repairs achieved excellent or good results. There were no tendon ruptures or extensor lags. No patients required secondary surgery for tenolysis or joint release. No wound complications occurred. The RIHM technique for primary extensor tendon repairs in zone IV and V and T1 to TIV is safe, allows for immediate controlled active motion in the fingers and an immediate dynamic extension protocol in the thumb, and achieves good to excellent functional outcomes. These clinical outcomes support prior biomechanical data. Therapeutic IV.

Fascial Augmentation Tenorrhaphy for Extensor Tendon Lacerations in the Forearm

Proximal lacerations of the extensor tendon apparatus can pose a surgical challenge, especially when located at the musculotendinous junction or in patients presenting late. We describe a technique to augment the suture repair of these injuries utilizing local harvested strips of dorsal forearm fascia.

Dynamic Splinting With Early Motion Following Zone IV/V and TI to TIII Extensor Tendon Repairs

To investigate the influence of a dynamic splinting protocol on outcomes of extensor tendon repairs. All patients in a prospectively collected database underwent extensor tendon repair by a single surgeon between 2004 and 2008. The inclusion criterion was simple extensor tendon repairs in zone IV and V in the fingers and zones TI to TIII in the thumb. The tendon repairs used a 4-strand core technique and running epitendinous suture. Within 7 days, each subject began using a dynamic extension splint during the day and a static extension splint at night. The extension splint allowed the patient to passively extend and actively flex the digits. After 3 weeks, the dynamic splint was discontinued and the patients were started on active digital motion. Static night splinting was continued for the next 3 weeks, after which time splinting was discontinued and strengthening was instituted. A total of 17 patients with 19 tendon lacerations met the inclusion criterion. There were 5 patients with lacerations of the thumb extensors and 12 patients with zone IV/V finger extensor tendon lacerations. The average time from injury to surgery was 11 days (range, 2-39 d). The follow-up was 43 to 215 days, with an average of 96 days. A total of 16 patients achieved good or excellent results by 6 weeks according to our grading system. One patient had a fair result. There were no ruptures and no tenolysis surgeries performed. Dynamic splinting resulted in generally good functional outcomes for extensor tendon laceration repairs in zone IV/V and TI to TIII, without complications. Therapeutic IV.

Comparing Three Postoperative Treatment Protocols for Extensor Tendon Repair in Zones V and VI of the Hand

This pilot study compared the effectiveness of 3 postoperative rehabilitation protocols for patients with Zones V and VI extensor tendon lacerations. Twenty-seven patients were recruited from 3 sites and randomly assigned to 1 of 3 established treatment protocols: immobilization, early passive motion (EPM), and early active motion (EAM). Outcome measures were collected at 3, 6, and 12 wk after treatment and included total active motion (TAM). At the end of Week 12, data on 24 injured digits of 18 patients were available for analysis. When data at Weeks 3, 6, and 12 were compared, patients in all groups showed steady improvement in TAM, but digits under the EAM treatment improved to a greater extent over time (F[2, 46] = 75.6, p < .001). Patients with Zones V and VI extensor tendon injuries treated with the EAM protocol recovered range of motion more rapidly.

HS12P THE DONA TECHNIQUE FOR FDP AND EDC TENDON FIXATION TO THE DISTAL PHALANX

Purpose: Common methods of repair of zone 1 flexor digitorum profundus (FDP) or extensor tendon avulsion or laceration are the modified Bunnell pullout and suture anchor techniques. While these techniques have extensive use clinically, results show a 75% fair to poor outcome. We present a simple technique for repairing these injuries and discuss its rationale.Methodology: A retrospective analysis was undertaken on a consecutive cohort of 5 patients that were treated by the relatively simple method of (1) securing the FDP tendon stump with a 4‐0 Fibreloop suture in a standard Kessler suture configuration (2) creation of transosseous tunnels and (3) passing the sutures through the base of the distal phalanx and then tying them volar to the FDP tendon stump, which effectively results in a 4 strand tendon and 4 strand transosseous suture repair.Results: Six month follow up of MCP, PIP, and DIP joint flexion was 99%, 95%, and 86% of that of the uninjured side, respectively, with no complications. All patients were able to return to their pre‐injury level of functioning and employment, with no further operations required. This technique has also been employed when repairing open mallet finger injuries. Additionally, similar principles are used when repairing volar plate avulsion injuries.Conclusion: The technique avoids the morbidity associated with both the pullout button and suture anchor techniques, while providing an inexpensive, and highly reproducible, four‐strand biomechanically sound repair that allows an early active mobilization protocol to maximize return of function.

Return to Work in the Setting of Upper Extremity Illness

HE PATIENT ary is a 44-year-old woman who sustained a simple ong finger extensor tendon laceration at the midetacarpal level at work 5 months ago. Surgical repair as straightforward. She had difficulty getting to hand herapy due to family issues, but she did participate in a -month program and regained full motion. Her theraist noted disproportionate complaints of pain, particuarly when discussing return to work (RTW). Three years before the injury she was disabled for 1 ear due to upper extremity pain that she describes as eing due to repetitive trauma. She states that she did ot feel normal even when she returned to work. Mary has confided that she has a stressful relaionship with her supervisor at work. Presently, here are no findings on examination or diagnostic tudies that explain Mary’s pain complaints. She oes not feel that she can return to her job, and she eports that her employer does not want her back nless she can return without restrictions. She decribes her job as fast paced and requiring frequent eavy lifting. Mary has not been in contact with ny of her co-workers since the accident. She xpressed hope that you will not make her return to ork. Her attorney is pursuing litigation against er employer and is requesting a letter from you egarding permanent disability. Her worker’s comensation carrier wants to know whether she is leared for duty and indicates that they can accomodate any restrictions.

Complication of emergency cesarean section: Open metacarpophalangeal disarticulation and complete extensor tendon lacerations of the hand in a neonate

Complication of emergency cesarean section: Open metacarpophalangeal disarticulation and complete extensor tendon lacerations of the hand in a neonate

Augmented (Massachusetts General Hospital) Becker Technique Combined With Static Splinting in Extensor Tendons Repairs Zones III to VI

The purpose of this study was to investigate the value of the augmented Massachusetts General Hospital (MGH) Becker extensor tendon repair, a strong 4-strand technique that allows mobilization of repaired tendons after only 3 weeks of postoperative static splinting. In the prospective study, we used the augmented Becker (MGH) suturing technique with 4-0 Ethilon. Eighteen patients had extensor tendon lacerations repaired with augmented Becker (MGH) technique. Results were compared with the uninjured hand and statistically evaluated. Postoperatively patients were immobilized 3 weeks in a volar splint and then fully mobilized with physiotherapy. Three months postoperatively, all patients had final assessment for total active motions of fingers; extensor lag; range of motion for the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints; and pulp-to-palm distance. Eighteen patients with 20 tendon lacerations were included in the study. At the final assessment, average total active motion of fingers was 268 degrees without a statistically significant difference between this and the uninjured side (P = 0.0584). The average pulp-to-palm distance was 0 cm. There were no wound complications or ruptures of repaired tendons. Augmented (MGH) Becker technique is an adequate 4-strand extensor tendon repair technique that allows mobilization of patients after only 3 weeks of static splinting postoperatively. Injured fingers can then be safely mobilized with expected return of function at 3 months postoperatively.

(iii) Twenty questions on tendon injuries in the hand

Summary Recovery to full function following a tendon injury in the hand continues to be a challenge; therefore, the surgeon requires a detailed knowledge of anatomy, tendon healing, repair techniques, injury patterns and evolving rehabilitation methods to best treat these injuries. Particularly with flexor tendon injuries, current surgical techniques have significantly decreased rupture rates and controlled postoperative mobilization has reduced tendon adhesions that historically complicated repair attempts. In addition to open flexor and extensor tendon lacerations, this review also discusses closed tendon injuries in the hand, including flexor digitorum profundus (FDP) and extensor pollicis longus (EPL) ruptures, and mallet and boutonniere deformities.