Optimization of the treatment of finger extensor tendon injuries in 1st zone

Despite the apparent simplicity of diagnosis and treatment of injuries of the finger extensor tendons, the number of unsatisfactory outcomes reaches 10-15.7 %, and 61.2 % in combined injuries. The small volume of extensor excursions (a small lever to the joint), unlike the flexors, requires a special attitude to the surgical restoration of the extensors. The accuracy of extensor length recovery is an essential factor in successful treatment. Purpose of the study was to develop diagnostic and surgical algorithms for the treatment and rehabilitation of hammer-like deformity of the fingers. Material and methods The study included two groups of patients with dropped distal phalanx of the fingers. The control group consisted of patients (n = 149) with a separation of the extensor tendon from the tuberosity of the nail phalanx. The main group (n = 163) were patients with tendon rupture at the level of the joint space. Patients in both groups underwent radiographic and ultrasound examination. Evaluation of the results was carried out using the subjective DASH criterion and objective assessment according to J.P. Crawford. Results Most patients in the control group were diagnosed with a tendon separation from the tuberosity of the nail phalanx. These patients were treated with a diagnosis of damage to the extensor tendons of the fingers in the 1st zone. Thus, the treatment tactics did not correspond to the diagnosis and is the reason for the deficiency of extension of the distal phalanx of the fingers of the hand after conservative therapy. According to the evaluation criterion (J.P. Crawford), the distal phalanx was observed in the majority of patients (n = 132), and according to the subjective assessment of DASH, only 45 could not fully perform these tests. In the patients of the main group at the diagnostic (ultrasound) stage, the position in the joints of the fingers of the hand was revealed, where the diastasis approached maximally between the damaged ends of the extensor tendon of the fingers of the hand in the 1st zone. Assessment of treatment results in this group of patients according to J.P. Crawford received excellent and good results, and according to DASH, all patients were able to perform these actions. Conclusions For the diagnosis of drooping distal phalanges of the fingers, it is necessary to apply x-ray and ultrasound examinations. Patients with an extensor tendon separation from the tuberosity of the nail phalanges should undergo surgical treatment using the blocking suture method. After surgical treatment of patients with subcutaneous rupture of the extensor tendons of the fingers in the 1st zone, immobilize the hand in the physiological position.