J Hand Microsurg 2016; 08(01): 002-012
DOI: 10.1055/s-0036-1572534
Review Article
Society of Indian Hand & Microsurgeons

Traumatic Extensor Tendon Injuries to the Hand: Clinical Anatomy, Biomechanics, and Surgical Procedure Review

Giulia Colzani
1   Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, AOU Città della Salute e della Scienza, Torino, Italy
,
Pierluigi Tos
1   Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, AOU Città della Salute e della Scienza, Torino, Italy
,
Bruno Battiston
1   Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, AOU Città della Salute e della Scienza, Torino, Italy
,
Giovanni Merolla
2   Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, AUSL della Romagna, Misano Adriatico RN, Italy
,
Giuseppe Porcellini
2   Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, AUSL della Romagna, Misano Adriatico RN, Italy
,
Stefano Artiaco
1   Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, AOU Città della Salute e della Scienza, Torino, Italy
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Publikationsverlauf

09. September 2015

10. Januar 2015

Publikationsdatum:
27. April 2016 (online)

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Abstract

The extensor apparatus is a complex muscle-tendon system that requires integrity or optimal reconstruction to preserve hand function. Anatomical knowledge and the understanding of physiopathology of extensor tendons are essential for an accurate diagnosis of extensor tendon injuries (ETIs) of the hand and wrist, because these lesions are complex and commonly observed in clinical practice. A careful clinical history and assessment still remain the first step for the diagnosis, followed by US and MR to confirm the suspect of ETI or to investigate some doubtful conditions and rule out associate lesions. During last decades the evolution of surgical techniques and rehabilitative treatment protocol led to gradual improvement in clinical results of ETI treatment and surgical repair. Injury classification into anatomical zones and the evaluation of the characteristics of the lesions are considered key points to select the appropriate treatment for ETI. Both conservative and surgical management can be indicated in ETI, depending on the anatomical zone and on the characteristics of the injuries. As a general rule, an attempt of conservative treatment should be performed when the lesion is expected to have favorable result with nonoperative procedure. Many surgical techniques have been proposed over the time and with favorable results if the tendon injury is not underestimated and adequately treated. Despite recent research findings, a lack of evidence-based knowledge is still observed in surgical treatment and postoperative management of ETI. Further clinical and biomechanical investigations would be advisable to clarify this complex issue.