Extensor Tendon Repair Research Articles

Comparison of the Repair Techniques for Extensor Tendon Injuries in the Hand By IJISRT

Fifty three patients (97 fingers) with extensor tendon injures in the metacarpal and wrist zones were included in this prospective study, with average age of 28 years. Metacarpal zone was involved in 70% of cases and extensor tendon was injured in 82 fingers and 15 thumbs, 62% of the patients were treated surgically within 7 days of injury. In general, mattress suturing technique was used in 65 digits (67%) Kessler in 21 (22%) and Cruciate11 (11%) with splinting range between 4 to 6 weeks. After average of 5 months follow up, the results scored according to millers classifications; was excellent in thirty one fingers ( 32%), good in 49( 50.5%), fair in 14 (14.4) and poor in 3( 3.1%).In thumb, in 60% the Cruciate technique was used and Kessler in 33% and the results were excellent to good in 80% . In the other fingers, Mattress technique of suturing was used in 78%, and the Cruciate in 2.5%. 25 fingers (30.5%) were classified as excellent,43(52.5%) good, and unsatisfactory in 14(17%).In conclusion, we found that Mattress suture technique is simpler and quicker, it can be used in the repair of multiple small flat extensor tendons in multi- injured fingers. And augmented 2-strand Kessler and 4- strand cruciate techniques are stronger extensor tendon repair techniques that allows early and safely mobilization, in one or two injured fingers with tubular shape or thicker tendons.

A Review of 1228 In-Office Hand Surgery Procedures With Wide Awake Local Anesthesia No Tourniquet (WALANT) at a Single Private Practice.

This study examined the complication rate of Wide Awake Local Anesthesia No Tourniquet (WALANT) technique in the clinic setting with field sterility at a single private practice. We hypothesized that WALANT is safe and effective with a low complication rate. This retrospective chart review included 1228 patients who underwent in-office WALANT hand procedures at a single private practice between 2015 and 2022. Patients were divided into groups based on type of procedure: carpal tunnel release, A1 pulley release, first dorsal compartment release, extensor tendon repair, mass excision, foreign body removal, and needle aponeurotomy. Patient demographics and complications were recorded; statistical comparisons of cohort demographics and risk factors for complications were completed, and P < .05 was considered significant for all statistical comparisons. The overall complication rate for all procedures was 2.77% for 1228 patients including A1 pulley release (n = 962, 2.7%), mass excision (n = 137, 3.7%), extensor tendon repair (n = 23, 4.3%), and first dorsal compartment release (n = 22, 8.3%). Carpal tunnel release, foreign body removal, and needle aponeurotomy groups experienced no complications. No adverse events (e.g. vasovagal reactions, digital ischemia, local anesthetic toxicity, inadequate vasoconstriction) were observed in any group. Patients with known autoimmune disorders and those who were currently smoking had a statistically significant higher complication rate. Office-based WALANT procedures with field sterility are safe and effective for treating common hand maladies and have a similar complication profile when compared to historical controls from the standard operating room in an ambulatory center or hospital.

The Influence of Insurance Status on Extensor Tendon Repair Outcomes

Background: Little is known regarding how patient insurance status influences outcomes after extensor tendon-injury repair. We aim to establish a relationship between the outcomes of primarily repaired extensor tendon injuries and patient insurance status. We hypothesize that commercially insured patients will achieve superior outcomes due to more facile access to postoperative hand therapy and fewer barriers to appropriate postoperative care. Methods: A retrospective chart review was conducted of patients who underwent primary extensor tendon repair in any zone, excluding the thumb, at a single large safety-net hospital. Inclusion criteria included a minimum of eight weeks of follow-up, complete data available for review, and an extensor tendon injury requiring primary surgical repair. Four cohorts were examined: patients with commercial insurance, patients with Medicare/Medicaid, patients with county hospital-sponsored insurance, and uninsured patients. Statistical analysis was performed using Chi-Square and ANOVA analyses, with significance defined as p ≤ 0.05. Results: Of the 62 patients (100 digits) included, 20 had commercial insurance, 12 had Medicare/Medicaid, 13 had hospital-sponsored insurance, and 17 were uninsured. Except for mean age, there were no significant differences between groups in terms of demographic data, medical comorbidities, or digit characteristics. There were also no significant differences in mean follow-up, time to return to full activity, or surgical complications among groups. Procedure duration differed significantly between groups, with procedures lasting longer in uninsured patients. Postoperative final flexion total arc of motion (TAM) and extension measurements were similar across all groups. Additionally, hand therapy visits did not differ significantly between groups. Conclusions: Following extensor tendon repair, patient insurance status did not affect outcomes in terms of final range of motion, return to full activity, or postoperative complications.

Relative motion splint versus static splint in extensor tendon repair: comparative study

Relative motion splint versus static splint in extensor tendon repair: comparative study

Safety of immediate open traumatic extensor tendon repair performed at an emergency department minor procedure room.

The superficial location of the extensor tendons makes them particularly vulnerable to lacerations. Patients most commonly present to the emergency department (ED) after these injuries. We aimed to measure the safety of immediate surgical repair of traumatic open extensor tendon injuries in an ED minor procedure room (MPR) under local anesthesia, and the associated post-operative infection and complication rates. We retrospectively evaluated all patients undergoing traumatic open extensor tendon repairs in the ED MPR over a 3.75-years period. Data collected included demographic information, comorbidities, mechanism of injury, additional procedures performed, and post-operative complications. All patients were operated under local anesthesia by a hand surgery fellow aided by an ED technician. Two hundred and forty eight patients (278 tendons) were treated for extensor tendon injuries during the study period. 220 patients (245 tendons) have complied with follow-up. No intra-procedural medical complications were encountered. The post-operative infection rate was 1.4%. The rate of other post-operative complications was not related to the number of tendons repaired, additional digit involvement, or if the nature of the injury was work-related. In this cohort, traumatic extensor tendon repairs performed in an ED MPR were found to be medically safe and to associate with a low postoperative infection rate. As preoperative assessment is simple and practical, and limited medical personnel is utilized, this surgical setting may enable us to reduce medical costs.

Postoperative Management Early Active Mobilization of Extensor Tendon Repair at Zone (V-VII)

Background: The extensor tendons are particularly vulnerable to trauma because their superficial location in a clenched fist, the thin mobile subcutaneous tissue offers little protection, and lacerations of the extensor tendons are common over joints that are easily exposed to contamination. Objective: To assess the evaluation of the postoperative early active mobilization protocol of extensor tendon repair at zone (V-VII). Methods: In this prospective study was carried out at Orthopedic Dept., 250 Bed General Hospital, Kishoreganj, Bangladesh from January to June 2023. Total 40 cases of fresh injury of extensor tendon at zone V to VII were treated. A protocol of early active mobilization was undertaken, using an easy to follow rehabilitation plan. Routine history taking with details of the injury, the object causing the injury, the dominant hand and the position during the injury, Physical examination, included the zone, and the possible tendons involved together with any associated injury. Results: Forty patients of fresh extensor tendon injuries were included in this study, their ages ranged from 20 to 55 years. There were 33 males (82.5%) and 7 females (17.5%). The dominant hand was involved in 29 of patients (72.5%). The nature of injuries was sharp cut in 34 patients (85%), with crush injuries in 6 patients (15%). The most common site of injuries was zone VI, VII and zone V respectively, and the most common tendon injured was EDC, EI, and EDM. Only 7 patients (17.5%) had single tendon injury, While 33 patients (82.5%) had multiple tendon injuries. At the end of the 6th weeks post operatively, the overall outcome result are summarized. Conclusion: The early mobilization of repaired extensor tendon reduces the formation of adhesion as compared to rigid immobilization. We recommend the use of this protocol following extensor tendon repair in the hand at zone V, VI, and VII in cooperative patient. It will give fairly acceptable results.

527 BSSH Standards of Care in Hand Trauma: The Impact of COVID-19 on Timing to Treatment

Abstract Aim To evaluate the compliance of our regional unit against the British Society for the Surgery of the Hand (BSSH) standards of care in hand trauma (BSSH, 2020) following an increase in our WALANT practice post-pandemic. Method A retrospective audit of two parallel 6-month periods was undertaken in our unit in Greater Manchester. Group 1 (pre-pandemic) comprised of cases managed at our main site from September 2019 – February 2020. Group 2 (post-pandemic) consisted of patients managed under the newly devised regional and national WALANT guidance at our sister site between September 2020 – February 2021. Data collection involved cross-referencing multiple databases. Exclusion criteria included delayed presentation, no injury identified at time of surgery, re-rupture and re-operation. Results Number of cases across the 2 study periods were almost identical (group 1 = 451, group 2 = 449). There was an improvement in compliance post-pandemic (78.86%) versus pre-pandemic (75.4%); this was not statistically significant (p = 0.283). We observed a significant improvement in compliance for patients undergoing extensor tendon repair (pre-pandemic = 68.97%, post-pandemic = 85.94%, p = 0.42). This was not the case for the other sub-groups (table 1). Crucially, we observed a &amp;gt;50% reduction in GA cases post-pandemic (14.92%) compared to pre-pandemic (66.08%). Conclusions Despite a significant reduction in anaesthetic team input, we have achieved similar levels of compliance as pre-pandemic across multiple domains whilst observing improved compliance for extensor tendons.

Extensor Tendon Repair: Avoidance and Management of Complications.

Extensor tendon repair can be technically challenging and can lead to suboptimal outcomes and complications even if managed perfectly. This article describes the pertinent clinical anatomy of the extensor mechanism, reviews outcomes and complications following extensor tendon repair, and provides guidance on how to avoid and manage complications when they occur.

Functional Recovery Measurement: Comparing Early Active Mobilization Versus Immobilization after Extensor Tendon Repair in Zones IV to VIII

Objective: To compare the results of early active mobilization versus immobilization in term of rehabilitation after extensor tendon injury in zones IV–VIII. Study Design: Randomized control trial (Clinical Trial no. NCT04221113). Place and Duration of Study: Department of Plastic and Reconstructive Surgery, Dr. Ruth K.M. Pfau Civil Hospital, Karachi Pakistan, from Feb to Jul 2020. Methodology: Patients with extensor tendon injuries of zone IV–VIII were randomly allocated to Treatment Group (early Active Mobilization) and Comparison Group (Immobilization Group) and their total active motion score was observed at fourth, sixth and eighth week. Results: Overall mean age of study participants was 29.48±5.51 years. Half of the patients had single finger injury 25(50%). Most of the study participants presented with injury in zone V 32(64%). The two groups did not differ on basis of age (p=0.879), gender (p=1.00), zone involved (p=0.183) and finger involved (p=0.396). TAM score between the two groups was not significantly different at fourth week (p=0.384), sixth week (p=0.606) and eighth week (p=0.122). The frequency of complications between two groups was not statistically significantly different (p=0.667).Conclusion: The current study was unable to find the significant difference in patients’ outcomes when treated with early active mobilization and immobilization protocol.

The Outcomes of Extensor Tendon Repair Based on Timing of Repair.

Background: Little is known regarding the effect timing of repair has on extensor tendon repair results. The purpose of this study is to determine if a relationship exists between the time of extensor tendon injury to extensor tendon repair and patient outcomes. Methods: A retrospective chart review was conducted on all patients that underwent extensor tendon repair at our institution. The minimum time to final follow-up was 8 weeks. Patients were then divided into two cohorts for analysis; those that underwent repair less than 14 days after injury and those that underwent extensor tendon repair at or greater than 14 days after injury. These cohorts were further sub-grouped by zone of injury. Data analysis was then completed using a two-sample t-test assuming unequal variance and ANOVA for categorical data. Results: A total of 137 digits were included in final data analysis, with 110 digits repaired less than 14 days from injury and 27 digits in the greater than or equal to 14 days to surgery group. For zones 1-4 injuries, 38 digits were repaired in the acute surgery group and eight digits in the delayed surgery group. There was no significant difference in final total active motion (TAM) (142.3° vs. 137.4°). Final extension was also similar between the groups (2.37° vs. 2.13°). For zones 5-8 injuries, 73 digits were repaired acutely, and 13 digits were repaired in delayed fashion. There was no significant difference in final TAM (199.4° vs. 172.7°). Final extension was also similar between the groups (6.82° vs. 5.77°). Conclusions: We found time from extensor tendon injury to surgical repair did not affect final range of motion when comparing acute repair within 2 weeks from injury or delayed repair greater than 14 days from injury. Additionally, there was no difference in secondary outcomes, such as return to activity or surgical complications. Level of Evidence: Level IV (Therapeutic).

Hand Therapy after Flexor and Extensor Tendon Repair: Assessing Predictors of Loss to Follow-up

Charts were retrospectively reviewed for patients who underwent extensor or flexor tendon repair of the hand, wrist, or forearm between 2014 and 2019. Demographic data, including age, sex, zip code, employment status, education level, and insurance type, were collected, and the rate of LTFU was calculated. Logistic regression was used to analyze factors. A total of 149 patients were identified and analyzed. The rate of LTFU was 42%. Factors that predicted loss were younger age, male gender, lower educational degree, and a documented psychiatric history. Employment status, insurance type, and distance from the HT center did not predict attrition. The number of HT weeks recommended by the occupational therapist did not differ between those who were lost and those who were not. Lost patients completed, on average, 57% of their suggested HT course. The current study identified demographic factors associated with attrition in patients undergoing tendon repair of the distal upper extremity. Factors included patients who were younger, male gender, less educated, and had a documented psychiatric history. By identifying factors that predict LTFU, specific strategies can be developed to reduce attrition rates, particularly for at-risk populations, to improve patient care after tendon repair.

Systematic review: Zone IV extensor tendon early active mobilization programs

Study DesignSystematic review IntroductionEarly active mobilization (EAM) of tendon repairs is preferred to immobilization or passive mobilization. Several EAM approaches are available to therapists; however, the most efficacious for use after zone IV extensor tendon repairs has not been established. Purpose of the StudyTo determine if an optimal EAM approach can be identified for use after zone IV extensor tendon repairs based on current available evidence. MethodsDatabase searching was undertaken on May 25, 2022 using MEDLINE, Embase, and Emcare with further citation searching of published systematic/scoping reviews and searching of the Australian New Zealand Clinical Trials Registry, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. Studies involving adults with repaired finger zone IV extensor tendons, managed with an EAM program, were included. Critical appraisal using the Structured Effectiveness Quality Evaluation Scale was performed. ResultsEleven studies were included, two were of moderate methodological quality, and the remainder was low. Two studies reported results specific to zone IV repairs. Most studies utilized relative motion extension (RME) programs; two utilized a Norwich program, and two other programs were described. High proportions of “good” and “excellent” range of motion (ROM) outcomes were reported. There were no tendon ruptures in the RME or Norwich programs; small numbers of ruptures were reported in other programs. ConclusionsThe included studies reported minimal data on outcomes specific to zone IV extensor tendon repairs. Most studies reported on the outcomes for RME programs which appeared to provide good ROM outcomes with low levels of complications. The evidence obtained in this review was insufficient to determine the optimal EAM program after zone IV extensor tendon repair. It is recommended that future research focus specifically on outcomes of zone IV extensor tendon repairs. Level of EvidenceI.

Use of a relative motion flexion orthosis with dorsal hood to protect a middle phalanx finger fracture and zone III extensor tendon repair, while correcting a secondary fixed flexion proximal interphalangeal joint flexion contracture: A case report

BackgroundProximal interphalangeal joint (PIPJ) contractures, zone III extensor tendon injuries and phalanx fractures are challenging to treat in isolation. In this case the patient presented with all 3 of these issues in a single digit, presenting a unique problem for the hand therapist. PurposeA case report to examine the effectiveness of using single orthosis to treat an index finger following a combined zone III extension tendon repair, surgically stabilized second phalanx fracture and PIPJ flexion contracture. MethodsA patient presented to therapy with a 40° PIPJ flexion contracture and minus 70° of active PIPJ extension (ICD10 M25.64) after left index surgical fixation of a middle phalanx fracture (ICD10 S62.621B) and zone III extensor tendon repair (ICD10 S66.321A). To correct the contracture, a distal elastic strap was added to a relative motion flexion orthosis with dorsal hood. This applied a gentle extension force to the PIPJ. Once the contracture resolved a short arc motion program (SAM) was initiated using the same orthosis. ResultsAt 20 weeks post initial therapy evaluation, active range of motion (extension/flexion) of the PIPJ was 5°/100° and distal interphalangeal joint (DIPJ) 0°/60°. The Quick DASH score improved 50 points from an initial 59 points to 9 points. The patient reported good satisfaction and full function of the hand. ConclusionOur case report demonstrated the effective use of a single relative motion flexion orthosis with a dorsal hood when treating a complex hand injury involving an open zone III injury, second phalanx fracture and 40-degree PIPJ contracture.

Extensor Tendon Repair Outcomes Based on Zone of Injury.

The purpose of this study was to examine the clinical outcomes of extensor tendon repairs based on zone of injury. A retrospective chart review was conducted on all patients who underwent primary extensor tendon repair at our institution. Extensor tendon repairs were performed using a multiple figure-of-8 suture technique for extensor zones 1-4 and a modified Kessler suture technique for extensor zones 5-8. Inclusion criteria included a minimum of 8 weeks of follow-up, complete data available for review, and extensor tendon injury requiring primary surgical repair. A total of 132 digits were included for analysis: 46 digits in zones 1-4 and 86 digits in zones 5-8. The operative time for zone 1-4 injuries averaged 88.96 minutes, and the operative time for zone 5-8 injuries averaged 114.42 minutes. Final extension was found to be 2.33° for zones 1-4 and 6.66° for zones 5-8. Final flexion was found to be 141.4° for zones 1-4 and 195.3° for zones 5-8. There was 1 infection identified in zones 1-4 and 7 in zones 5-8. Surgically repaired extensor tendons in zones 1-4 were found to have a statistically significant worse final flexion compared with surgically repaired extensor tendons in zones 5-8. No significant differences were found in final extension, complication rates, and time to full activity. Operative times for zone 5-8 tendon repairs were found to be significantly longer than operative times for zone 1-4 repairs, possibly due to more complex injury patterns seen in the more proximal zones.

Quantifying the Impact of COVID-19 on Hand and Wrist Surgery Procedural Volume: A National Analysis of 381,046 Cases

The purpose of this study is to quantify and describe the impact of the COVID-19 pandemic on procedural volume trends in hand and wrist surgery in 2020 through early 2022 at multiple centers. In this retrospective comparative study, a real-time, national, federated research database was utilized to identify patients of interest from 56 healthcare organizations across the United States. Patients were queried from March 1, 2018, through February 28, 2022. Current Procedural Terminology (CPT) codes were chosen using the Accreditation Council for Graduate Medical Education's Hand Fellowship procedure requirements. Common hand and wrist surgeries exhibited substantial fluctuations in procedural volume per healthcare organization during the COVID-19 pandemic. Time periods with considerable procedural volume decreases corresponded with surges of increased COVID-19 caseloads and the emergence of COVID-19 variants. Periods of procedural volume increase occurred in summer 2020 as well as immediately following distribution of the COVID-19 vaccine to the general public. Fixation of metacarpal fracture, fixation of phalangeal fracture, tendon transfer, flexor tendon repair, and extensor tendon repair consistently showed decreased volumes over the study period. In contrast, ulnar nerve decompression was the only procedure to experience a statistically significant increase in volume over an entire year (2021) as compared to before the pandemic. Major milestones of the COVID-19 pandemic correlated with fluctuations in the number of hand and wrist procedures performed across the United States. Future studies should seek to evaluate the impact of patient backlogs and individual procedure fluctuations on financial impacts, patient outcomes, and orthopaedic trainee experience.

Comparison of Outcomes in Primary Extensor Tendon Repair of Hand Treated in a Tertiary Care Hospital

Objective: To determine different treatment outcomes of early extensor tendon repair according to the zone of injury.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Department of Plastic Surgery, Dr Ruth K.M. Pfau Civil Hospital, Karachi Pakistan, from Jun 2019 to May 2020.&#x0D; Methodology: Seventy-four patients, more than 17 years of age and either gender, presenting to the emergency department of a tertiary care hospital for repair of lacerated extensor tendons of hand were enrolled in the study. All the procedures were performed in an operating room under general or local anaesthesia by a consultant plastic surgeon with experience of 5 years. Tendon repairs were performed using modified Keisler's technique. After wound closure, hand splinting was provided for six weeks. Outcomes were assessed per Miller's Classification at six weeks, two months, and three months post repair and classified as excellent, good, moderate and bad.&#x0D; Results: The mean age of study participants was reported as 30.69±12.86 years. Zone II (36.4) and VI (47.2) were the most common location of laceration. Of all patients with Zone II lacerations, 33.3 achieved excellent outcomes, and 29.5 achieved a good outcome. Further, in patients with zone VI, 68.5 of the patients achieved good to excellent outcomes.&#x0D; Conclusion: According to Miller's Classification, the study showed excellent results with zone IV and II injuries. Zone V and 8 had good outcomes, whereas zone I and II showed moderate to bad outcomes. There was no statistical association between the proportions of outcomes and zone of injury.

Palmaris Longus Inversus Muscle Present Bilaterally in an 82 Year-old White Female Cadaver and Unilaterally in a 68 Year-old White Female Cadaver

The palmaris longus muscle is one of the most variable muscles in the human body. Palmaris longus muscle anatomical variations include reversed (palmaris longus inversus muscle), duplicated, triplicated, bifid, hypertrophied, accessory (additional) slips, and/or complete absence. During anatomical dissection of fifty cadavers in the 2019 undergraduate first-year anatomy course at the Uniformed Services University of the Health Sciences, we found a palmaris longus inversus muscle bilaterally on an 82 year-old White female cadaver and a unilateral palmaris longus inversus muscle on the right forearm of a 68 year-old White female cadaver. Due to the prevalence of anatomical variations in the palmaris longus muscle, adequate knowledge of such prevalence and clinical significance is needed in multiple medical specialties for its reconstructive use, and the possibility and treatment of clinical syndromes. An accessory (additional) palmaris longus muscle, hypertrophied palmaris longus muscle, hypertrophied palmaris longus inversus muscle, or just the presence of a palmaris longus inversus muscle, can all cause compression to adjacent neurovascular structures, such as the median nerve, ulnar nerve, ulnar artery, and/or the anterior interosseous artery, in the distal forearm and wrist. Palmaris longus tendons are used as grafts in various surgeries, such as extensor tendon repair in rheumatoid arthritis patients, injuries of flexor tendons and repair, lip augmentation, reconstructive hand surgery, frontalis suspension sling in ptosis correction, plastic surgery, and pulley reconstructions. Surgeons, physicians, radiologists, and physiotherapists must be knowledgeable of the many PLM anatomical variations and their possible contributions to pathological processes.

Palmaris Longus Inversus Muscle Present Bilaterally in an 82‐Year‐old Cadaver and Unilaterally in a 68‐Year‐old Cadaver

The palmaris longus muscle is one of the most variable muscles in the human body. Palmaris longus muscle anatomical variations include reversed (palmaris longus inversus muscle), duplicated, triplicated, bifid, hypertrophied, accessory (additional) slips, and/or complete absence. During anatomical dissection of fifty cadavers in the 2019 undergraduate first‐year anatomy course at the Uniformed Services University of the Health Sciences, we found a palmaris longus inversus muscle bilaterally on an 82‐year‐old white female cadaver and a unilateral palmaris longus inversus muscle on the right forearm of a 68‐year‐old white female cadaver. Due to the prevalence of anatomical variations in the palmaris longus muscle, adequate knowledge of such prevalence and clinical significance is necessary in various medical specialties for its use in reconstructive surgery, and the possibility and treatment of clinical syndromes. An accessory (additional) palmaris longus muscle, hypertrophied palmaris longus muscle, hypertrophied palmaris longus inversus muscle, or just the presence of a palmaris longus inversus muscle, can all cause compression to adjacent neurovascular structures, such as the median nerve, ulnar nerve, ulnar artery, and/or the anterior interosseous artery, in the distal forearm and wrist. Palmaris longus tendons are used as grafts in a variety of surgeries, such as extensor tendon repair in rheumatoid arthritis patients, injuries of flexor tendons and repair, lip augmentation, reconstructive hand surgery, frontalis suspension sling in ptosis correction, plastic surgery, and pulley reconstructions. Surgeons, physicians, radiologists, and physiotherapists must be knowledgeable of the many palmaris longus muscle anatomical variations and their possible contributions to pathological processes.

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.

Wide-Awake Olecranon Tension Band Wiring with Ipsilateral Zone 6 Extensor Tendon Repair: A Case Report

Wide-awake local anaesthesia, no tourniquet (WALANT) continues to gain popularity and has been adapted for various fracture fixations proximal to the hand. A case of olecranon tension band wiring with concomitant extensor tendon repair is presented. The procedure was done with the patient awake in a lateral decubitus position 30min after the injection of WALANT solution at the intended surgical sites. Pain and discomfort were felt by the patient towards the end of the procedure mainly on his volar forearm where the bolster was placed. Olecranon fixation under WALANT is a viable alternative for patients who prefer to be awake or those with contraindications to general or regional anaesthesia. Alternative patient positioning may be considered, and perioperative pain control should not be overlooked.