Complex extensor tendon injuries: early active motion following single-stage reconstruction

This study presents a retrospective evaluation of patients managed with single-stage repair following complex extensor tendon injuries. Over a 2-year period, 21 extensor tendons were reconstructed in 18 patients with complex hand injuries in zones V-VII. All eight patients needed soft tissue cover. Active mobilisation was started in the first week. Total active motion (TAM) at 4 weeks was a mean of 159 degrees (SD 21.57) and at 6 weeks it was 202.6 degrees (SD 13.26). Average TAM at 8 weeks was 223.8 degrees (SD 16.46) and 249.5 degrees (SD 14.38) at 12 weeks. Grip strength at 12 weeks and 6 months was around 75% and 90% of the contralateral normal hand in most of the patients. Single-stage reconstruction of complex extensor tendon injuries seems to reduce morbidity in terms of hospitalisation, and reduced cost of treatment. It also helps to achieve better functional outcome in the early postoperative period.     

Two-stage extensor tendon reconstruction after composite tissue loss from the dorsum of the hand

Restoration of digital extension after chronic extensor loss has not been detailed extensively in the literature. The present report details an unusual case of composite tissue loss from the dorsum of the hand after a chronic burn wound. After debridement for chronic carpal osteomyelitis and free-tissue transfer were performed, staged wrist fusion and two-stage extensor tendon reconstruction resulted in a stable, pain-free wrist and functional digital extension. The present case illustrates that two-stage extensor tendon reconstruction, when necessary, is indeed feasible.     

A consideration of the tendons in hand injuries

I have given directions for the diagnosis of tendon injuries and for the exposure and identification of the cut ends, from nerves as well as from other tendons. In addition, I have expressed my personal conclusions regarding the disposal of the tendons in operations involving the loss of part of a digit.     

Functional reconstruction of bilateral injuries to the dorsum of hand using radial forearm tendocutaneous flaps

Abstract

We treated a patient with skin and tendon defects of both hands as a result of injury by a heat press. There have been no reports of bilateral hand injuries being treated using simultaneous bilateral tendocutaneous flaps. In this case, we reconstructed the injured tissue using simultaneous bilateral radial forearm tendocutaneous flaps, with satisfactory results.     

The excursions of the long extensor tendons of the hand

In a cadaveric study in seven hands, the mathematical relationship between extensor tendon excursion and joint motion (wrist, m.p., p.i.p. and d.i.p.) has been investigated. This has been found to be linear at all joints, allowing the mean tendon excursions corresponding to ten degrees of joint motion to be calculated for each of the above joints for all five rays of the hand. A table of these excursion values is presented as a reference for calculation of clinical problems.     

Rupture of extensor tendons associated with a palmar perilunar dislocation

Extensor tendon ruptures associated with a palmar perilunar dislocation have never reported in the literature. We describe a 20-year-old man with rupture of the finger extensor tendons associated with a palmar perilunar dislocation, and the mechanism of the tendon rupture.     

Repair of extensor tendon injuries of the hand

We have presented methods for treating extensor tendon injuries from the interphalangeal joint to the wrist and the musculotendinous junction in the forearm. Early and proper splinting in the treatment of extensor tendon injuries is more important than a specific method of surgical repair. We emphasize the need for prolonged splinting, up to eight weeks in distal injuries. Immobilizing the finger in full extension or hyperextension is necessary at the distal and proximal interphalangeal joints. Correct splinting is mandatory in any method of treatment. Reconstruction of the extensor mechanism is difficult and the results are unpredictable.     

Flexor and extensor tendon injuries of the hand

Injuries of the flexor tendon are usually open injuries. In most cases primary treatment is therefore seldom performed by orthopaedic surgeons. This is different for injuries of the extensor tendon. Three quarters of injuries of the extensor tendon are closed injuries. Therefore we do go into primary and secondary reconstruction of the flexor tendon, but focus on primary and secondary reconstruction of the extensor tendon in the most common zones (1, Th I, 3, Th III).     

Flap reconstruction following high pressure injection injuries of the hand: a report of three cases.

High pressure injection injuries are well known to cause significant injury to the hand, with high amputation rates and poor functional outcome. Surgical treatment consists of early aggressive debridement followed by secondary closure. Flap reconstruction is a reconstruction option which can increase the chance of digit salvage, as well as give an acceptable functional and cosmetic result. We review three cases of flap reconstruction following high pressure injection injuries, and discuss their role in the treatment of these injuries.     

An uncommon occupational accident: tuberculous tenosynovitis of the extensor tendons of the hand

We present a case of tuberculous tenosynovitis of the extensor tendons of the hand. Our patient was a young doctor working in the respiratory medicine department. He was injured on the dorsal aspect of the hand with a needle used for pleural aspiration. The clinical features consisted of gradually swelling, mild pain and stiffness of the metacarpophalangeal joint. The diagnosis was made after synovectomy. Histological and bacteriological examinations revealed tuberculosis. Treatment consisted of synovectomy and appropriate antibiotics. The clinical course was excellent after one year follow-up. Tuberculous tenosynovitis of the hand is a rare manifestation of extrapulmonary tuberculosis occurring in fewer than 5% of all cases of skeletal tuberculosis. Thickening of the tendon or synovial sheath and local accumulation of fluid are the characteristic manifestations. The diagnosis must be confirmed by surgical biopsy. Antibiotics and synovectomy achieve a good functional result.     

An anatomic study of the extensor tendons of the human hand.

A total of 548 upper limbs (276 right and 272 left hands) from Japanese cadavers were dissected. The arrangements of extensor indicis proprius, extensor digitorum communis (EDC), and extensor digiti minimi tendons and the intertendinous connections were studied. The most common pattern of extensor tendons was as follows: the index finger had a single EDC tendon, the middle finger had a single EDC tendon, the ring finger had a single EDC tendon, and the small finger had a single EDC tendon or a single common EDC tendon distributed to the ring and small finger. A single extensor indicis proprius tendon ran along the ulnar side of the EDC, and the extensor digiti minimi tendon consisted of 2 slips. Intertendinous connections were classified into 3 types: type 1 with a filamentous band, type 2 with a fibrous band, and type 3 with a tendinous band subdivided to r-shaped and y-shaped. The most common patterns were type 1 in the second intermetacarpal space (IMCS), type 3r in the third IMCS, and type 3y in the fourth IMCS.     

Dislocation of extensor tendons of the hand caused by focal myoclonic epilepsy

A case of dislocation of the extensor tendons of the hand caused by focal myoclonic epilepsy is presented. This particular aetiology, which has not previously been reported, is discussed. The tendons were repositioned and there was no sign of recurrence one year later.