The Challenges in restoration of extensor tendons function at the hand

Area of Science:

• Hand Surgery
• Orthopedic Surgery
• Reconstructive Surgery

Background:

• Restoring finger extensor function after distal posterior interosseous nerve or tendon complex injuries presents significant challenges.
• Patient-specific requirements and lesion typologies necessitate individualized treatment strategies.

Purpose of the Study:

• To discuss and present solutions for challenging cases of extensor function loss at the finger level.
• To highlight surgical techniques for restoring finger extension in complex injury scenarios.

Main Methods:

• Case report of a patient with extensor digitorum communis (EDC) lag (zones 6B-8) treated with flexor carpi ulnaris (FCU) tendon transfer using cadaveric grafts.
• Case report of a young patient with a distal posterior interosseous nerve lesion treated with selective tendon transfers to the extensor pollicis longus (EPL) and extensor indicis proprius (EIP) for index extension.

Main Results:

• Successful restoration of finger extension was achieved in both cases, leading to high patient satisfaction.
• The EDC lag case demonstrated the efficacy of prolonged FCU tendon transfer with grafts.
• The distal posterior interosseous nerve lesion case successfully restored selective and autonomous index extension.

Conclusions:

• Distal posterior interosseous nerve lesions in demanding patients may require selective tendon transfers for fine motor skills like autonomous index extension.
• Significant extensor tendon loss (zones 6-8) necessitates bypass tendon transfers, often prolonged with cadaveric grafts.
• Available surgical techniques serve as crucial "escape plans" to address specific reconstructive needs.