Treatment Of Extensor Tendon Injuries Research Articles

Treatment of extensor tendon injuries of the hand

The extensor apparatus of the hand is acomplex system consisting of extrinsic and intrinsic muscles, which in combination enable the individual extension of the fingers. Extensor tendon injuries of the hand are frequent injuries and the operative or conservative treatment options are determined by the localization and involvement of osseus structures. For an optimal outcome of the treatment of extensor tendon injuries, correct diagnostics and aconsistent hand aftercare are absolutely essential. The crucial decision making regarding the further procedure starts with the initial patient treatment, ideally on the day of trauma.

El ekstansör tendon yaralanmalarında primer onarımın fonksiyonel sonuçlarının etiyolojik faktörler, eşlik eden yaralanmalar ve yaralanma yerlerine göre değerlendirilmesi

Purpose: The aim of this study was to evaluate the effect of surgical treatment of extensor tendon injuries in the hand with appropriate primary repair techniques on clinical and functional outcomes, taking into account the mechanism of injury, concomitant injuries and injury sites.
 Materials and Methods: This is a cross-sectional study in which 103 patients who were operated between 2016-2020 in Orthopedics and Traumatology Clinic were evaluated retrospectively. Existing treatment modalities were evaluated in terms of etiological factors, anatomical regions, number of injured tendons, and injuries. Complications and functional outcomes were statistically evaluated according to anatomical regions, mechanism of injury and additional injuries.
 Results: 114 extensor tendon injuries of 103 patients (mean age: 37.2 years) were evaluated. The mean follow-up period was 26.8 months. Among the etiological factors, it is seen that the most common one is sharp object injury (57.3%). According to the Miller classification performed at the 8th week and 12th month in sharp object injury, moderate and poor outcome and the presence of complications were found to be statistically significantly lower than other injury types. A statistical correlation was observed between the accompanying injury (n: 21/103) and the occurrence of complications and functional outcomes. While there is no difference between complications, depending on the body regions, and functional results at 8. week statistically significantly lower functional results were found in zone-2 injuries at 12 months.
 Conclusion: While successful postoperative recovery primarily depends on the type of injury and associated injuries, good and excellent functional results can be achieved with early mobilization after surgery with the appropriate repair technique in any region.

Extensor injuries at the zoneI of the digits

Injuries of the extensor tendon in zoneI are frequently seen. If detected early and treated appropriately they are associated with good functional results. Open injuries are primarily treated surgically by suturing the injured tendon. Closed injuries without bone involvement are treated conservatively. In cases of bone involvement the treatment procedure is determined by the articulation and the extent of fragment displacement. This article presents the current state of knowledge on the diagnostics and treatment of extensor tendon injuries in zone I with the aim of providing treatment recommendations for the clinical routine.

Effect of Aftercare Regimen With Extensor Tendon Repair: A Systematic Review of the Literature

Over the past several years, advances in the treatment of extensor tendon injuries have focused mainly on changes to postoperative protocols. Traditional static splinting has been found often to result in loss of flexion as well as extension lags at the metacarpophalangeal and interphalangeal joints. In addition, early motion, once thought to increase the risk of tendon rupture, has shown encouraging results. The purpose of this article was to conduct a systematic review of the literature to determine the optimal postoperative protocol following extensor tendon repair. A systematic review was conducted of PubMed and Cochrane databases to identify all English-language clinical papers reporting results on the surgical treatment and rehabilitation of extensor tendon injuries. Returned articles were reviewed and included in the study if they reported clinical outcomes following surgical repair. A statistical consultation was placed to aid with data analysis. Nineteen studies were included. Of these, eight studies used static splinting (437 tendons), 12 used dynamic splinting (600 tendons), and five used active motion (240 tendons) for their postoperative protocols. Six studies were comparative, two of which reached level I evidence, while the remaining 13 studies were case series, with level IV evidence. Overall, generally favorable results were found for all three regimens with a high degree of variability with respect to outcomes measures reported and methods used for reporting. Quantitative statistical analysis of outcome measures was not possible given this variability. However, complication rates were as follows: static splinting complication rate was 4.1% with 1.8% requiring tenolysis and 0.9% tendon ruptures, dynamic splinting complication rate was 4.3% with 3.2% extensor tendon lags and 0.2% tendon rupture, and early motion complication rate was 1.7% with 0.8% tendon ruptures. Functional results, when reported, were generally favorable for all three postoperative regimens; however, standardized reporting of functional results is needed for quantitative analysis. Early active motion protocols following extensor tendon repair provides a relatively lower complication rate than other postoperative regimens.

Strecksehnenverletzungen der Hand

The treatment of extensor tendon injuries of the hand is based on Verdan's division of the different sections into eight zones. Taking the anatomic characteristics of those zones into consideration, good functional results can be achieved in most cases by differentiating between indications for operative or conservative treatment. The most frequent extensor tendon injury of the hand is the closed tendon rupture over the DIP joint. In almost all cases it can be completely cured by immobilization for at least 8 weeks. Open extensor tendon injuries on the other hand require surgical therapy. This paper gives a clearly arranged overview of the different therapeutic options.

Early controlled active mobilization with dynamic splintage for treatment of extensor tendon injuries

Early controlled active mobilization with a dynamic splint for treatment of repaired extensor tendon injuries was studied prospectively. Postoperative dynamic splintage started on the third postoperative day and involved elastic band extension and active flexion of the digits. Mobilization of the digits within the splint was done immediately under supervision. Range of motion was stepped up progressively and splintage was stopped after 5 to 6 weeks. Thirty-eight patients with 48 digits were reviewed. The average follow-up was 6.7 months (range, 4 to 10 months). Injuries involving the fingers showed an average final total active motion of 229 degrees (range, 95 to 270 degrees), whereas injuries involving the thumb was 118 degrees (range, 78 to 150 degrees). Lesions distal to the knuckles (zones II, III, IV) showed the worst results with an average total active motion of only 188 degrees (range, 95 to 270 degrees). The duration out of work was 8.5 weeks (range, 4 to 25 weeks). There was no infection or acute tendon rupture. One patient required reconstruction of a persistent button-hole deformity; two required tenolysis and capsulotomy. Of the six unsatisfactory results with poor total active motion, four had injuries distal to the metacarpophalangeal joint, three of which were crushing injuries.

Management and Rehabilitation of Extensor Tendon Injuries

The keys to the treatment of extensor tendon injuries are knowledge of the anatomic characteristics of the area, the correct position of immobilization of the wrist and fingers, and the timing for institution of active and resistive exercises.

Repair of extensor tendon injuries of the hand

We have presented methods for treating extensor tendon injuries from the interphalangeal joint to the wrist and the musculotendinous junction in the forearm. Early and proper splinting in the treatment of extensor tendon injuries is more important than a specific method of surgical repair. We emphasize the need for prolonged splinting, up to eight weeks in distal injuries. Immobilizing the finger in full extension or hyperextension is necessary at the distal and proximal interphalangeal joints. Correct splinting is mandatory in any method of treatment. Reconstruction of the extensor mechanism is difficult and the results are unpredictable.

Extensor injuries of the hand : McFarlane R. M. and Harmpole M. K. (1973), ‘Treatment of extensor tendon injuries of the hand’, Can. J. Surg., 16, 366

Extensor injuries of the hand : McFarlane R. M. and Harmpole M. K. (1973), ‘Treatment of extensor tendon injuries of the hand’, Can. J. Surg., 16, 366

Treatment of extensor tendon injuries of the hand

Treatment of extensor tendon injuries of the hand