[Primary treatment of acute extensor tendon injuries of the hand].
OBJECTIVE
Reconstruction of extensor functions after extensor tendon injuries of the hand.


METHODS
Acute injuries of extensor mechanism with corresponding loss of function.


METHODS
Complex injuries with loss of soft tissue. Limited possibility of extensor tendon reconstruction with combined injuries of the interphalangeal joints (in situations with irreparable joints: primary arthrodesis).


METHODS
The treatment of extensor tendon injuries depends on the various levels of tendon laceration. Zones 1 and 2: in case of tendon disruption close to the base of the distal phalanx, refixation of tractus terminalis using a pull-out suture. In case of disruption more proximally, primary repair using mattress sutures. Temporary pinning of the distal interphalangeal joint in extension using a single transarticular Kirschner wire. Zone 3: mattress sutures of the tractus intermedius. Temporary pinning of the proximal interphalangeal joint in extension using a single transarticular Kirschner wire. Zone 4: reconstruction of the central slip and the lateral slip of extensor tendon using modified Becker sutures and mattress sutures. Temporary pinning of the proximal interphalangeal joint in extension using a single transarticular Kirschner wire. Zones 5 and 6: four-strand modified Becker sutures with additional epitendinous suture. Zones 7 and 8: core sutures using modified Kirchmayr techniques with additional epitendinous suture.


METHODS
Zones 1-4: immobilization of the finger for 6 weeks with removal of the transarticular wire at 4 weeks. Zones 5-8: dynamic postoperative treatment in intrinsic-plus splint for 6 weeks.


RESULTS
It is postulated that dynamic postoperative treatment leads to improved functional outcome after extensor tendon injuries. While for zones 1-4 no better final clinical results are observed using the dynamic postoperative protocol, early protected motion for zones 5-8 is superior to static post operative treatment.
Arora
Rohit
R
Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstrasse 35, Innsbruck, Austria. rohit.arora@uki.at
Lutz
Martin
M
Gabl
Markus
M
Pechlaner
Sigurd
S
D000208:Acute Disease; D001864:Bone Wires; D005081:Exercise Therapy; D005383:Finger Injuries / Q000601:surgery*; D005384:Finger Joint / Q000502:physiology / Q000601:surgery; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D007103:Immobilization; D011182:Postoperative Care; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013165:Splints; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome