"Extensor Tendon Injuries", Dr. Mark A. Deitch, M.D.

, Johns Hopkins University, Presented at the Orthopaedic Review Course,

Baltimore, June, 2003

Extensor Tendon Injuries

Extensor
Tendon Injuries

Should be treated with same degree of

skill and care
Common because of superficial
location

Mark A. Deitch, MD
Chief, Hand & Microvascular Surgery
Johns Hopkins Bayview Medical Center
June 25, 2003

Anatomy

Less likely to retract after laceration

Anatomy
Dorsal extensor mechanism

Extensor
retinaculum
Juncturae Tendinae
Long, ring & small
fingers
Course distally and
obliquely
Transmits extension
to adjacent finger

Intrinsic system (median and ulnar

nerves)
Extrinsic system (radial nerve)
Dorsal extensor hood (sagittal bands)

Oblique
interconnections

Anatomy
Proximal phalanx
Lateral bands join extensor tendons

Extensor tendon
Central slip
Lateral bands
Tension important (Boutonniere)

"Extensor Tendon Injuries", Dr. Mark A. Deitch, M.D., Johns Hopkins University, Presented at the Orthopaedic Review Course,
Baltimore, June, 2003

Extensor Tendon Zones

Tendon Nutrition
Zone VIII
Musculotendinous junction

Zone VII
Mesotendon

Zones I VI
Perfusion via paratenon

Dorsal Apparatus
EDC extend MCP via sagittal bands
Intrinsics muscles resist MCP
hyperextension
NOT palmar plate

Intrinsics extend PIP and DIP

Intricate coordination of
flexors/extensors
Injury or adhesions can upset b
balance

Extensor Tendon Injuries

Rehab
Traditional
Immobilization -3 4weeks
Wrist at 40
- 45 extension
Fingers in slight flexion
Problems: adhesions

Extensor Tendon Injuries

Rehab
Dynamic Splinting:
Controlled mobilization
Active flexion
Passive extension
Addition of dorsal block
Holds MCP in 15 flexion

Zone I-II: static splint only

"Extensor Tendon Injuries", Dr. Mark A. Deitch, M.D., Johns Hopkins University, Presented at the Orthopaedic Review Course,
Baltimore, June, 2003

Dynamic Extension Splint

Treatment
Repair within 7-10 days
Meticulous technique to decrease
adhesions
3-0 or 4-0 suture

Suture techniques

Treatment
Zones V VIII
Modified Kessler or Bunnell

Zones III, IV
Kessler, Bunnell better than figure of eight
Newport et al, 1995

Zones I, II
Techniques less well defined
Pin DIP joint

Closed Extensor Tendon Injuries

Mallet deformity
Boutonniere deformity
Swan Neck deformity
Sagittal Band rupture

Mallet Finger
Extensor tendon disruption at distal
phalanx insertion
Mechanism
Forceful flexion of extended digit
bony avulsion
Open or crush injuries

"Extensor Tendon Injuries", Dr. Mark A. Deitch, M.D., Johns Hopkins University, Presented at the Orthopaedic Review Course,
Baltimore, June, 2003

Mallet finger

Mallet Finger
Treatment
Static splinting
8 weeks
80% G/E results
Need compliant patient

K-wire fixation
Tendon repair

Boutonniere Deformity

Disruption of central slip at PIP joint

Palmar migration of lateral bands
Loss of PIP extension
Hyperflexion at DIP
Deformity gradually develops 2-3wk

"Extensor Tendon Injuries", Dr. Mark A. Deitch, M.D., Johns Hopkins University, Presented at the Orthopaedic Review Course,
Baltimore, June, 2003

Boutonnieres Deformity
Treatment

Boutonnire Deformity

Closed Injuries
Splinting with gradual progressive PIP extension

Open injuries
Direct tendon repair
K-wire fixation of PIP joint
Gradual mobilization

Late presentation
Many techniques
Contracture release

Boutonnire Deformity

Boutonnire
Deformity

Boutonnire Deformity

Boutonniere Deformity

"Extensor Tendon Injuries", Dr. Mark A. Deitch, M.D., Johns Hopkins University, Presented at the Orthopaedic Review Course,
Baltimore, June, 2003

Swan Neck Deformity

Due to pathology:
Proximal to PIP joint
P-1 fracture

PIP joint
Synovitis + palmar plate insufficiency

Distal to PIP joint

Mallet finger

THANK YOU!!