Novel approaches to extensor tendons: Strong surgical repairs with flexor tendon repair principles

Extensor tendons in the dorsal hand especially at or close to the metacarpophalangeal joint area and those of the thumb are solid and round in cross-sections. A survey shows that most surgeons are using less strong surgical repair methods, often with over-protection after surgery. In this article, strong surgical repairs (6-strand repairs) are recommended for these areas based on author's experience. These tendons are treated with surgical methods and principles of current flexor tendon surgery. The finger is protected with short splinting with early active motion or hand use. After the extensor tendon repair at or close to the MCP joint, a short splint is used for protection, mainly serving to avoid inadvertent hand use or injury. Early gentle use of the hand and the repaired fingers is allowed. A relative extension splint can be used in these patients. After repair of the extensors in the thumb, a long splint is used, but out-of-splint early active motion with a protocol the same as for flexor tendons is used. Many principles of flexor tendon repairs should be applicable to these areas of extensor tendons in making a strong surgical repair and early active motion after surgery.