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Recent Developments Are Changing Extensor Tendon Management.

Wyndell H Merritt1, Alison L Wong1, Donald H Lalonde1

  • 1From the Division of Plastic Surgery, Virginia Commonwealth University/Medical College of Virginia; Department of Plastic Surgery, University of Virginia; Division of Plastic Surgery, Queen Elizabeth II Health Sciences Center; and Dalhousie University.

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Summary

Early protected movement with relative motion splinting accelerates recovery for extensor tendon injuries. This approach allows patients to resume daily activities sooner after surgery for conditions like boutonniere deformities.

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Area of Science:

  • Hand surgery
  • Orthopedic rehabilitation
  • Tendon repair outcomes

Background:

  • Extensor tendon injuries, including boutonniere deformities, traditionally require prolonged immobilization.
  • Conventional splinting (3-4 weeks) can lead to stiffness and delayed functional recovery.
  • Advances in surgical and splinting techniques offer potential for improved patient outcomes.

Purpose of the Study:

  • To describe modern surgical and rehabilitation techniques for extensor tendon injuries.
  • To highlight the benefits of relative motion splinting in managing these injuries.
  • To explain new advances in extensor tendon management, including wide-awake surgery.

Main Methods:

  • Focus on surgical and rehabilitation strategies for extensor tendon injuries from the PIP joint to the wrist.
  • Utilizes relative motion flexion and extension splinting.
  • Incorporates wide-awake, local anesthesia, no tourniquet (WALANT) surgical techniques.

Main Results:

  • Early protected movement (3-5 days post-surgery) is facilitated by relative motion extension splinting for zone 5 extensor tendon lacerations.
  • Patients can return to regular activities significantly sooner compared to traditional splinting protocols.
  • Rehabilitation of boutonniere deformities is enhanced with relative motion splinting.

Conclusions:

  • Relative motion splinting revolutionizes extensor tendon injury management.
  • Early protected motion leads to faster return to activities and improved rehabilitation.
  • WALANT surgery and relative motion splinting represent significant advances in hand surgery.