Extensor Tendon Lacerations

Wounds over the dorsum of the hand and fingers may involve extensor tendons. These lacerations must be examined through complete range of motion, paying particular attention to reconstructing the position of injury. Extensor tendon lacerations that are proximal to the MCP joint in some cases can be repaired by an emergency physician who is experienced and comfortable with the procedure.7 Many methods are used for extensor tendon laceration repair. One simple and effective method is a figure-of-eight suture (Fig 40.-7). This method places the knot on the side of the tendon, making it less obvious under the skin after repair.

Nonabsorbable 4-0 suture should be used. Consultation and follow-up with a hand surgeon are recommended. Extensor tendon lacerations over the distal interphalangeal joint result in mallet finger (Fig, 4.0.-.8A), and those over the proximal interphalangeal joint result in a boutonniere deformity ( Fig._40-.8B). These are treated with splinting for 6 weeks when closed, but when they are open, they require surgical repair. 8 Tendon lacerations of the thumb should be repaired by a hand surgeon.

FIG. 40-7. Extensor tendon laceration repair with a figure-of-eight stitch.

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