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Published on: December 10, 2021
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Extensor tendon injuries: a new classification, strong repairs, and easier therapy.
1From Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China, and Department of Plastic Surgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Plastic and Reconstructive Surgery
|September 30, 2025
Summary
A new 5-zone classification for hand and forearm extensor tendons is proposed. This system aims to standardize surgical techniques and improve patient outcomes through tailored repair and rehabilitation strategies.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Reconstructive Surgery
Background:
- Extensor tendon injuries in the hand and forearm lack a unified classification system.
- Current methods for surgical repair and postoperative management vary significantly.
- This variability can lead to inconsistent outcomes for patients.
Purpose of the Study:
- To introduce a novel 5-zone classification for extensor tendons in the hand and forearm.
- To correlate this classification with surgical repair methods and expected outcomes.
- To propose standardized treatment protocols based on the new zone system.
Main Methods:
- Development of a new 5-zone classification system for extensor tendons.
- Review of surgical repair techniques (e.g., 4-strand, 6-strand repairs) applied to different zones.
- Analysis of postoperative management strategies, including splinting and early active motion.
- Comparison of outcomes based on the proposed classification.
Main Results:
- The proposed classification unifies extensor tendon zones in fingers and thumbs.
- Zone 2 repairs consistently utilize 6-strand techniques.
- Zones 1c and 3 involve varied strand repairs, with early motion post-splinting.
- Zones 4 and 5 repairs use strong methods followed by early motion, often requiring tenolysis.
- Zones 1a and 1b present unique challenges, particularly complicated open injuries.
Conclusions:
- The new 5-zone classification provides a framework for regrouping surgical methods and discussing outcomes.
- Strong surgical repairs (e.g., 6-strand) are emphasized, particularly in Zone 2.
- Postoperative management involves tailored splinting and early active motion, with principles applicable from flexor tendon repairs.
- Further validation of the classification and simpler treatment approaches are recommended.
