Mateusz Gładysz FESSH prep

FESSH prep Tendon injuries

Extensor tendon injuries in zones IV–VIII and repair principles

Last reviewed v1.0

FESSH-092Tendon injuries●○○ basic

Regarding open extensor tendon injuries in zones IV–VIII and the principles of their repair:

  1. 1.In the Verdan zone system for extensor tendon injuries, odd-numbered zones overlie joints, so zone V lies over the metacarpophalangeal joint and zone VII over the wrist.

  2. 2.In a series of operatively treated open extensor tendon injuries, zone V was the zone most often injured in the fingers.

  3. 3.Associated bone, joint or soft-tissue injuries are uncommon with open extensor tendon injuries of the hand, affecting fewer than one in ten.

  4. 4.In a long-term review of extensor tendon repairs, loss of extension was both more frequent and larger than loss of flexion.

  5. 5.In cadaver zone IV extensor tendon lacerations, a modified Becker repair resisted gap formation and failure better than a double figure-of-eight repair.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-092
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. In the Verdan zone system for extensor tendon injuries, odd-numbered zones overlie joints, so zone V lies over the metacarpophalangeal joint and zone VII over the wrist.

    True

    Griffin and colleagues' review sets out Verdan's eight extensor zones: four odd-numbered zones over the joints and four even-numbered zones over the intervening tendon segments, numbered from distal to proximal. Zone IV lies over the proximal phalanx, zone V over the metacarpophalangeal joint, zone VI over the metacarpal and zone VII over the wrist.

    • Griffin M, Hindocha S, Jordan D, Saleh M, Khan W. Management of extensor tendon injuries. Open Orthop J. 2012;6:36-42. PMID 22431949

  2. 2. In a series of operatively treated open extensor tendon injuries, zone V was the zone most often injured in the fingers.

    True

    Patillo and Rayan reviewed 86 patients with 125 severed tendons treated over 11 years. Zone V was the most commonly affected zone in the fingers (27%). Sharp laceration was the commonest mechanism, and most of these lacerations were at or proximal to the metacarpophalangeal joints.

    • Patillo D, Rayan GM. Open extensor tendon injuries: an epidemiologic study. Hand Surg. 2012;17(1):37-42. PMID 22351531

  3. 3. Associated bone, joint or soft-tissue injuries are uncommon with open extensor tendon injuries of the hand, affecting fewer than one in ten.

    False

    In Patillo and Rayan's series, associated injuries to bone and soft tissue occurred in 46.7% of all injuries, and saw and crush or avulsion mechanisms predicted fractures and joint-capsule damage. Newport's long-term review found an associated fracture, dislocation, joint-capsule or flexor tendon injury in 60% of fingers, so radiographs and careful exploration belong to the assessment.

    • Patillo D, Rayan GM. Open extensor tendon injuries: an epidemiologic study. Hand Surg. 2012;17(1):37-42. PMID 22351531
    • Newport ML, Blair WF, Steyers CM. Long-term results of extensor tendon repair. J Hand Surg Am. 1990;15(6):961-6. PMID 2269792

  4. 4. In a long-term review of extensor tendon repairs, loss of extension was both more frequent and larger than loss of flexion.

    False

    In Newport's retrospective review of 101 digits, most treated with static splinting, more fingers lost flexion than lost extension, and the average loss of flexion was also greater. The authors concluded that loss of flexion may be a more significant complication of extensor tendon injury than previously thought. Results in zones 1–4 were significantly poorer than in zones 5–8.

    • Newport ML, Blair WF, Steyers CM. Long-term results of extensor tendon repair. J Hand Surg Am. 1990;15(6):961-6. PMID 2269792

  5. 5. In cadaver zone IV extensor tendon lacerations, a modified Becker repair resisted gap formation and failure better than a double figure-of-eight repair.

    True

    Woo and colleagues compared four repairs in 48 cadaver fingers. The modified Becker technique had the greatest strength to 1-mm and 2-mm gap and the highest ultimate strength, although it was the hardest to perform; the double figure-of-eight was quicker but weaker. Tendon shortening (1.9–2.4 mm) did not differ significantly between the techniques.

    • Woo SH, Tsai TM, Kleinert HE, Chew WYC, Voor MJ. A biomechanical comparison of four extensor tendon repair techniques in zone IV. Plast Reconstr Surg. 2005;115(6):1674-81; discussion 1682-3. PMID 15861073