0071643192.pdf

CONTRAINDICATIONS

■ Relative:

■ Zones 1 and 2 consist of the area over the DIP joint and the middle pha-

lanx, respectively. These usually require a hand surgeon consultation.

■ Mallet finger deformity: Unopposed action of the flexor digitorum

profundus tendon due to disruption of the terminal extensor mech-

anism resulting in inability to extend at the distal interphalangeal

(DIP) joint

■ Zone 3 tendon (the area over the PIP joint) with penetration into the

joint; if tendon is not carefully repaired, it can result in long-term

deformity

■ Boutonniere deformity: Rupture of the central slip leading to unop-

posed flexion of flexor digitorum superficialis tendon at the PIP

joint and extension of the DIP joint

■ Absolute:

■ Zones 7 and 8 (dorsal wrist and forearm) injuries are not repaired in

the ED because risk of adhesions following repair and possible retrac-

tion of tendons past retinaculum that make repair difficult.

TECHNIQUE

■ Assess neurovascular status of injured hand and fingers.

■ Obtain X-ray to evaluate for associated fractures/dislocations.

■ Visualize location of tendon injury and locate both ends to be repaired.

■ Larger tendons may allow sutures to pass through the core of the tendon

but smaller tendons require a modified Kessler or Bunnell core suture

technique with 4-0 nonabsorbable suture.

■ After repair of a lacerated extensor digitorum commmunis (EDC) tendon

in zone 6, a volar splint should be applied so that the wrist is in 45°of

extension, the affected MCP joint is in neutral (0°of flexion), and the

unaffected MCP joints are in 15°of flexion. The PIP and DIP joints

should be allowed full range of motion.

■ There are inadequate data to prove the value of prophylactic antibiotics

for extensor tendon injuries, and no standard of care exists. If doubt exists

concerning contamination and potential for infection, antibiotics should

be given.

COMPLICATIONS

■ Infection

■ Tendon rupture

■ Restriction of PIP and MCP joint flexion due to tendon shortening or

adhesions

INTERPRETATION OFRESULTS

■ Return of tendon function demonstrates adequate repair. However, all

patients will need reevaluation and most require assistance with improving

range of motion.

Arthrocentesis

INDICATIONS

■ To obtain synovial fluid for analysis in order to differentiate joint disease

caused by crystal-induced arthritis or septic arthritis

■ To determine if an intra-articular fracture is present

PROCEDURES AND SKILLS

Use nonabsorbable suture to

repair tendons.