Subcutaneous rupture of the central portion of the extensor aponeurosis. Tendon rupture in the finger and its treatment
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Almost every year, patients come in who have not been diagnosed in a timely manner with subcutaneous ruptures of the extensor tendons of the fingers. Closed injuries of the extensor tendons of the fingers are observed on various levels, but most often - in the area of the distal interphalangeal joint, i.e., at the site of attachment of the extensor apparatus and in the area of \u200b\u200bthe proximal interphalangeal joint.
N. I. Pirogov (1843) noticed the functional unity of the common extensor of the fingers and the intrinsic muscles of the hand, which form the dorsal aponeurosis or extensor apparatus of the finger. The dorsal aponeurosis has the shape of a triangular plate, the top of which is attached to the distal phalanx, and the corners of the base are directed to the sides and proximally (Fig. 89).
The tendon of the common extensor of the fingers at the level of the proximal phalanx is divided into three bundles. The central bundle crosses the proximal interphalangeal joint and attaches to the base of the middle phalanx. The lateral parts of the common extensor tendon converge, merge into one bundle, which crosses the distal interphalangeal joint and attaches to the base of the distal phalanx. At the level of the metacarpophalangeal joint, the fascia of the rear of the finger forms transversely extending bundles.
Their distal part, which has an arcuate course, unites the tendon of the common extensor of the fingers with the fibers of the tendons of the own muscles of the hand that come to it from the sides. In this case, a kind of "hood" is formed, covering the joint from the rear and from the sides. When the finger moves, the "hood" slides freely over the back surface of the proximal interphalangeal joint.
Rice. 89. The extensor apparatus of the finger (according to N. I. Pirogov).
1 - opened bone-fibrous canal of the finger; 2 - tendon of the deep flexor of the fingers; 8 - a loop formed by splitting the tendon of the superficial flexor of the fingers; 4 - mesentery of the tendon; 5 - tendon of the common extensor of the fingers; c - tendons of interosseous and worm-like muscles; 7 - intertendon joints of the extensor apparatus of the finger.
In case of violation of the integrity of the central bundle of the extensor tendon with a rupture of the triangular ligament, the lateral fibers of the tendon are displaced to the palmar side. The head of the proximal phalanx protrudes through the resulting gap between the divergent lateral bundles of the extensor tendon (Fig. 90). The subsequent wrinkling of the lateral sections fixes the middle phalanx in the flexion position, and the distal phalanx in extension; there is a "symptom of the loop" - the so-called double contracture of the finger.
It must be constantly remembered that only flexion of the finger provides relaxation of the extensor apparatus. Fixation of the finger in an extended position in the treatment of injuries of the extensor apparatus is the most common mistake. For differential diagnosis it must be remembered that sprains in the distal interphalangeal joint of the fingers are rare, and bruises and tears of the extensor are more frequent. Therefore, an X-ray examination is always necessary.
Rice. 90. The characteristic position of the finger depending on the level of damage (indicated by an arrow) of the extensor tendon (a); splitting of the dorsal aponeurosis of the finger at the level of the proximal interphalangeal joint with subluxation of the middle phalanx of the fifth finger (b).
There are two types of subcutaneous rupture of the extensor apparatus of the finger at the level of the distal interphalangeal joint: rupture without damage and with bone damage, incomplete and complete. With the first, incomplete extensor movements of the distal phalanx are possible. With the second, extension is impossible, a "finger-hammer" is formed.
Rice. 91. Fixation of the distal interphalangeal joint with a metal plate with an adhesive plaster and a plaster cast (a, b); fixing the finger in the "writing" position (c); operation - suture of the extensor tendon (d).
Recognition of a subcutaneous rupture of the extensor tendon of the finger is not difficult if the surgeon pays due attention to the history and examination of the patient. This type of injury occurs more often after a sudden butt blow to the finger or direct support on the finger. In this case, the finger acquires the position and shape characteristic of a tendon rupture, and a corresponding loss of the extension function occurs - these are signs by which one can judge the level of damage to the extensor apparatus (see Fig. 90).
Treatment of subcutaneous ruptures of the extensor tendons. With regard to the treatment of subcutaneous injuries of the extensor tendons, there is currently no single view. Many authors recommend the use of surgical treatment - tendon suture with subsequent immobilization of the phalanx; other surgeons believe that good and at least not worse results can be achieved with conservative treatment. We adhere to this opinion in relation to subcutaneous ruptures of the extensor at the level of the distal interphalangeal joint. For ruptures in the area of the proximal joint, we consider surgical treatment indicated.
Success conservative treatment closed injuries of the extensor in the area of the distal interphalangeal joint depends on the timely recognition and complete immobilization of the finger. Having tried various methods and the timing of fixation and comparing the results, since 1938 we have been using immobilization of the finger in the "writing" position - extension in the distal and flexion in the proximal interphalangeal joint (Fig. 91) - for 4-6 units (E. V. Usoltseva, 1939). Fixation is carried out with a back gypsum, colloidal or sticky bandage, less often with a Kirschner wire. In elderly people suffering from age-related and metabolic changes in the interphalangeal joints, we limit ourselves to applying a splint in a half-bent position of the finger. For patients whose work requires differentiated movements of the distal phalanx, if immobilization fails, surgery is recommended.
Surgical treatment
Currently, surgeons continue to explore new ways to suture, secure, and hold the extensor tendon until it heals. Preference is given to internal splinting with a spoke and the Bennel method. The distal and proximal ends of the extensor are sutured with stainless steel wire or nylon thread. The ends of the thread are brought out distally and tied over the button. If necessary, the seam is supplemented with single seams from the sides, the integrity of the joint capsule is restored. After 3-4 weeks, the sutures are trimmed and pulled out. Immobilization of the finger is achieved with a plaster bandage or a transosseous Kirschner wire. When a tendon is torn with a bone fragment, a transosseous suture is used.
In case of damage to the extensor aponeurosis of the finger at the level of the proximal interphalangeal joint, various methods of tendoplasty are also offered in order to bring together the separated lateral bundles of the extensor tendon. Damage to the extensor tendon at the level of the proximal interphalangeal joint was studied by V. G. Vainshtein (1958). The purpose of the operation is to correct the deformity and restore the extensor apparatus of the finger. Correction is achieved after the allocation and restoration of the ratio of the lateral bundles, polerical and oblique fibers of the aponeurosis.
Most surgeons here and abroad believe that fresh subcutaneous injuries of the extensor tendons should be treated conservatively. The reason for the failures lies in non-compliance with the basic principles of the treatment of these injuries. The main mistakes include fixation of the injured finger in the extension position in the proximal interphalangeal and metacarpophalangeal joints and insufficient immobilization period - less than 4 weeks.
Operations should always be preceded by the elimination of stiffness and stiffness of the joints of the hand and an examination of the patient's state of health. The results of surgical restoration of the extensor apparatus at the level of the proximal interphalangeal joint are better than in the area of the distal joint. In the literature, there are isolated reports of more rare cases of subcutaneous injuries of the extensor tendons. thumb, own extensor of the II finger and other formations of the extensor apparatus.
E.V.Usoltseva, K.I.Mashkara
Surgery for diseases and injuries of the hand
TOPIC #20:HAND TENDON DAMAGE.
It is known that open injuries of the forearm, hand and fingers are often accompanied by tendon injury. Tendon injury in relation to all injuries of the hand is up to 21.3%, and damage to the flexor tendons is observed in 84.6%. Restoring the functions of the tendons of the fingers is a key moment in the rehabilitation of victims with hand injuries. The results of treatment of patients with damage to the flexor tendons, especially at the level of the phalanges, remain unsatisfactory in a significant percentage of cases.
Classification:
Depending on the type of tendon, there are:
Injury to the extensor tendons of the fingers.
Finger flexor tendon injury.
a) isolated superficial flexor.
b) isolated deep flexor.
c) both flexors.
DAMAGE TO THE FINGERS OF THE HAND.
There are 5 zones of damage to the tendons of the flexor fingers of the hand:
1 zone - above the middle phalanx
Zone 2 - from the metacarpophalangeal joint of the attachment of the superficial flexor to the middle phalanx.
Zone 3 - from the carpal canal to the metacarpophalangeal joint.
4 zone - carpal channel.
Zone 5 - above the carpal canal.
Diagnostics.
Determination of tendon damage is not very difficult, provided that you have a good knowledge of the topographic anatomy of the hand and a careful examination of the victim.
During the examination, it is necessary to pay attention to the localization of the wound and the position of the fingers. It is known that the fingers of the hand at rest are in a position of balance. If the flexor tendons are damaged, this balance is disturbed. A finger with damaged tendons takes on a position of greater extension than the rest. The main sign of damage to the flexor tendons is a violation of the functions of active flexion in the interphalangeal joints. The tendons of the deep flexors of the II-V fingers and the long flexor of the first finger are attached to the nail phalanges, the tendons of the superficial flexors of the II-V fingers to the middle phalanges, and the short flexor of the first finger to the main phalanx. If the tendons of the deep flexors of the II-V fingers and the long flexor of the I finger are damaged, the function of bending the nail phalanx drops out. With simultaneous damage to the tendons of the superficial and deep flexors, the function of bending the nail and middle phalanges of the II-V fingers drops out. If both flexor tendons of the first finger are damaged, the function of active flexion of the main and nail phalanges drops out. If the tendons of the above muscles are damaged, active flexion in the metacarpophalangeal joints of the II-V fingers can be carried out by the interosseous and vermiform muscles. When determining functions, it is necessary to fix the proximal phalanx in turn.
At the department, a more physiological and less traumatic method is used to detect damage to the flexor tendons: if damage to the flexor tendons is suspected, the nail and middle phalanges of the II-V fingers are passively bent. After that, the victim is asked to actively hold the phalanges in the flexion position. The inability to hold only the nail phalanx in the flexion position indicates damage to the deep flexor tendon, the inability to hold the nail and middle phalanges indicates damage to the tendons of both flexors. Often, damage to the tendons is combined with damage to the nerves and large vessels.
Treatment.
Damage to the tendons of the hand is an absolute indication for emergency surgical treatment. Surgical intervention should be performed only in a hospital setting. The degree of restoration of the function of the damaged hand depends not only on the severity of the injury, but also on the methods of surgical treatment (operative techniques), and the qualifications of the surgeon.
The type of anesthetic benefit is determined by the nature of the injury, the level and extent of damage, the scope of the proposed intervention, the age of the patient, and the general condition of the victim. Apply local, conduction anesthesia and general anesthesia.
It must be remembered that due to the contraction of the muscles of the damaged tendons, the diastasis between the ends can reach up to 5 cm. To detect the damaged ends of the flexor tendons in the wound, it is important to know in what position of the fingers the injury occurred. When wounded in the position of extension of the fingers, the peripheral end remains at the level of damage, and to find it, it is enough to bend the finger in the interphalangeal joints, while it is squeezed into the wound. In case of damage in the position of flexion of the fingers, the peripheral end of the tendon is significantly distal to the site of injury, and additional incisions below the site of injury are required to find it. In case of damage at the level of the lower arm, wrist joint and metacarpal bones, to detect the central end, maximum extension is performed in the joints of the fingers with intact tendons, while the damaged end, together with other tendons, is pulled into the wound.
The operation must be performed using a dosed tourniquet. Excision of the skin in torn, bruised, chopped wounds with a large area of damage should be very economical, but with the obligatory removal of non-viable skin scraps visible to the eye. After removing the damaged ends of the tendons into the wound, to prevent their subsequent displacement, it is advisable to fix them with an injection needle percutaneously. The found ends are refreshed by cutting off with a sharp razor 1-2 mm and a tendon suture is applied. The following types of sutures are used: classic Cuneo suture, Iselen suture, Friedrich and Lange suture, Bennel suture, double right angle suture, Vredan suture, Rozov suture, Kazakov suture (Fig. 27) and pulpit sutures (Fig. 28).
Rice. 27. Types of tendon sutures: a - Lange, b - Cuneo, c - Bloch and Bonnet,
d - Kazakov, d - Rozova, f - Bennel, w - Doletsky-Pugachev
Fig.28. Removable blocking tendon suture according to V.V. Lapin
in the 1st and 2nd modifications.
Depending on the area of damage to the flexor tendons, the following is carried out:
In case of damage in the first zone and diastasis between the tendon ends of more than 1 cm, a primary suture is performed, less than 1 cm - reinsertion is performed (attachment of the tendon to the place of separation from the bone).
The second zone is “critical”, the superficial flexor is excised to provide a sliding moment and prevent adhesions, only the deep flexor is sutured, and the central end is sutured to the deep flexor tendon.
In case of damage in the third zone, both flexors are sutured.
At the level of the fourth zone, the carpal canal is opened, both flexor tendons are sutured, and the carpal ligament is not sutured.
The fifth zone is favorable for the restoration of all damaged flexor tendons.
Contraindication to restore the anatomical integrity of the damaged finger flexor tendons should be considered:
the presence of wounds with a large area of damage and a defect skin and tendons, when it is not possible to connect the ends of the tendons and close the wound with local tissues;
signs inflammatory process in the wound.
Postoperative immobilization produced directly on the operating table in the position that the operated fingers occupy. If the tendons of one of the II-V fingers are damaged, all fingers are immobilized. Isolated immobilization of only one operated finger does not create complete rest for the restored tendon, since with active movements of the remaining fingers, the central end of the tendon is alternately tensioned at the level of the suture. If the tendons of the first finger are damaged, only one finger is immobilized. Immobilization period up to 3 weeks.
Postoperative period no less responsible than the operation itself. To prevent infectious complications, broad-spectrum antibiotics are prescribed. The first dressing is made on the second day. Dressings must be combined with ultraviolet irradiation of the hand, the appointment of magnetotherapy, UHF to reduce swelling and improve blood circulation. Skin sutures are removed 12-14 days after the operation. Ability to work is restored on average in 2-3 months.
Chronic injuries of the flexor tendons.
With periods of more than 3 weeks, tendon injuries are considered chronic, which creates certain difficulties for surgical treatment: large diastasis (up to 6-8 cm), the presence of cicatricial changes in the damaged area (which prevent slipping), etc.
As a rule, in these cases, two-stage methods of plastic surgery are used. Methods of tendon plasty with a graft with preserved or restored blood circulation of the ends of the tendons, with preliminary formation of an artificial tendon sheath, are used. However, in cases where, during revision, the diastasis between the ends does not exceed 4-5 cm, and the damaged tendons adapt without significant tension, it is possible to apply a secondary suture.
The following two-stage methods are used:
Method E. Lexer. If the tendon is damaged at a distance of up to 3 cm from the place of attachment of the distal phalanx. At the first stage of the operation, the distal segments of the tendons are excised and a PVC tube is implanted. At the second stage, the proximal segment of the tendon is dissected obliquely, the PVC tube is removed, and the dissected tendon is moved and fixed to the distal phalanx. The dissected tendon is sutured with lengthening.
Method E. Paneva-Khalevich. If the tendons are damaged at the level of the phalanges, at the first stage of the operation, the distal segments of the tendons are resected in their place and a vinyl chloride tube is implanted. The ends of the central segments of the tendons are sutured together. At the second stage of the operation of the tendon of the superficial flexor at the level lower third the forearms are crossed, turned 180 0 , the PVC tube is removed and the tendon is passed through the artificial vagina to the distal phalanx and fixed to it.
Tendon transposition. At the first stage, the distal segments of the tendons are resected, and a vinyl chloride tube is implanted in their place. At the second stage, the PVC tube is removed and the tendons of the superficial flexor, cut off at the point of attachment to the middle phalanx from the neighboring, healthy finger, are moved into the formed vagina and fixed to the distal phalanx.
In case of damage to the tendons at the level of the metacarpal bones, at the 1st stage of the operation, the ends of the distal segments of the tendons are sutured, and a vinyl chloride tube is implanted in the diastasis between the distal and proximal ends of the tendons. At the second stage of the operation, the distal segment of the tendon of the superficial flexor is crossed over the place of its division into legs, it is turned 180 0, the PVC tube is removed, it is passed through the artificial vagina and it is sutured to the end of the proximal segment of the tendon of the deep flexor.
DAMAGE TO EXTENDERS.
Depending on the level of damage to the extensor tendons, there are:
Damage to the extensor sail,
Damage to the middle portion of the extensor (at the level of the middle interphalangeal joint),
Injuries at the level of the metacarpal bones,
Damage at the level of H/3 of the forearm.
Damage can be open and closed.
Clinical manifestations are based on:
Lack of active extension of the nail phalanx,
Weinstein's contracture (in the middle interphalangeal joint),
Lack of active finger extension function.
Treatment.
In fresh cases of closed damage to the extensor sail, conservative methods of treatment are often used to create maximum hyperextension in the distal interphalangeal joint using a plaster splint or transarticular fixation with a Kirschner wire. However, they often do not give the desired result (the clinic remains after the removal of immobilization and rehabilitation treatment), which necessitates an operation. Choice of method surgical treatment depends on the ability to adapt the damaged ends of the tendon. The extensor sail is fixed with a transosseous suture to the nail phalanx, followed by immobilization in the hyperextension position. Or, in cases where there is a significant diastasis from the attachment zone, arthrodesis of the distal interphalangeal joint is performed in a functionally advantageous position.
In case of damage to the middle portion of the extensor, the lateral legs of the extensor are sutured over the interphalangeal joint. Immobilization is carried out on the palmar surface in the position of maximum extension of the finger.
In case of damage at other levels, a tendon suture is applied using one of the methods described above, or in chronic cases, the distal end is sutured to an intact, adjacent tendon. Immobilization is carried out with a plaster splint from the fingertips to elbow joint on the palmar surface, in the position of hyperextension in the wrist joint.
The immobilization period is at least 3 weeks.
Test questions.
Injury to the flexor and extensor tendons of the fingers: classification, diagnosis.
Principles of treatment of injuries of the tendons of the fingers.
Contraindications for surgical treatment.
Management of patients with tendon injuries in the postoperative period.
Features of immobilization of patients with tendon injuries.
Types of surgical treatment of chronic injuries of the flexor tendons of the fingers.
Injury to the extensor of the fingers, clinic, diagnosis, options for surgical treatment, immobilization.
The proper functioning of the hand is ensured by the coordinated work of the flexor and extensor tendons of the fingers.
The flexor tendons are located on the palmar surface of the hand, the extensor tendons - on the back. There are no muscles on the fingers, so their flexion and extension is carried out due to the tendons of the muscles located on the forearm.
Finger flexors are classified into superficial and deep. The tendons of the superficial muscles are attached to the middle phalanges of the fingers, and the tendons of the deep muscles are attached to the nail phalanges.
According to the data medical statistics, tendon injuries occupy the first place in the structure of all injuries of the hand and fingers. About 30% of all hand injuries are accompanied by partial or complete tendon ruptures.
Such statistics are due to the predominantly superficial location of the tendons, as a result of which they are extremely easy to damage even with minor injuries.
Tendon ruptures in the fingers are a serious sports and medical problem. The loss of thumb function reduces the overall functionality of the hand by 40%, the index finger by 20%, the middle finger by 20%, the ring finger by 12%, and the little finger by 8%.
Problems with the tendons of this localization are especially relevant among athletes who are involved in amateur sports.
Classification of tendon ruptures of the flexor and extensor of the fingers
Depending on the violation of the integrity of the skin, tendon ruptures can be open and closed.
Open injuries are most often preceded by wounds with piercing and cutting objects. Closed tears are most common in sports when a tendon is torn due to inadequate tension on the tendon.
Also, ruptures are classified into complete and partial, depending on the number of injured fibers. Complete tears are much more difficult to treat.
Damage to only one tendon is called isolated, and several - multiple. Combined injuries are spoken of when, in addition to tendons, other anatomical structures are injured: nerves, blood vessels, muscles.
Also very important for the choice of treatment tactics is the division of ruptures of the tendons of the flexors and extensors of the fingers into fresh (no more than 3 days from the moment of injury), stale (from 3 days to 3 weeks) and old (more than 21 days).
Causes of tendon ruptures
In general, tendon ruptures can be traumatic and degenerative in nature.
Degenerative rupture is a consequence of chronic muscle microtrauma, and traumatic rupture is an acute condition that occurs after a sharp lifting of weight. Sports injuries develop both according to the first and the second mechanism.
Here are the main risk factors for sports injuries:
- short recovery period between classes;
- lack of warm-up before sports training;
- excess body weight;
- the beginning of sports in old age;
- reassessment of their physical capabilities;
- irresponsible attitude to safety.
The main clinical symptoms of trauma
The symptomatology of damage is determined, first of all, by the localization of the gap.
Damage to the tendons on the anterior surface of the hand or fingers is accompanied by a violation of the function of flexion, as a result of which the fingers are in an overextended state. Conversely, with injuries to the posterior surface of the hand, the function of extension of one or more fingers suffers.
Nerve damage can lead to finger numbness and other sensory disturbances.
If you experience any of the above symptoms, contact your doctor immediately. Fresh breaks are much easier to treat than old ones.
Below are the addresses of the best sports clinics in Russia.
Basic methods of diagnosis and treatment
Tendon injuries are determined after standard diagnostic tests, during which the sports doctor asks the patient to bend and unbend the fingers in one sequence or another.
Diagnosis can be supplemented by an X-ray examination.
Conservative treatment is often ineffective, so the main method of treatment is surgery. It consists in cutting the skin and sewing together the ends of the torn tendon.
Rehabilitation after a rupture of the tendon of the finger includes passive exercises, exercise therapy and physiotherapy.
The recovery period is 2-3 months.
Making an appointment with a doctor
sports doctor after complete examination will be able to make a final diagnosis, on the basis of which treatment will be prescribed. You will also be offered recommendations regarding further sports activities.
The best sports clinics and doctors!
1. Manual therapy clinic of Dr. Chechil
Chechil Sergey Vyacheslavovich- The head physician of the clinic. The main direction is the musculoskeletal system. Behind him 24 years medical experience: management of the medical service of a nuclear submarine, management of the special training department of the Paratunka military sanatorium in Kamchatka.
Kovtun Yury Vadimovich– Neurologist, chiropractor, specialist in the selection and installation of individual orthopedic insoles. Certified kinestotaping specialist.
Clinic videos
Clinic website - www.chechil.com
2. Moscow Scientific and Practical Center for Sports Medicine
— Traumatologist-orthopedist of the traumatology department.
Clinic website - mnpcsm.ru
3. Clinic "Family"
Devis Andrey Evgenievich- Traumatologist-orthopedist. Doctor of the highest category.
Clinic website - Semeynaya.ru
Sport-TEK company for beautiful and healthy amateur sports!
In order to quickly find the addresses of the best sports clinics in Russia in Moscow, if necessary, we advise you to add this article to your browser bookmarks.
The reasons: mostly - cut wounds hands and fingers.
Signs: typical localization of the wound and the impossibility of active flexion of the finger. To determine damage to the deep flexor of the finger, it is necessary to fix the middle phalanx: the absence of active flexion of the nail phalanx indicates damage to the deep flexor tendon. In cases of damage to both flexors with a fixed proximal phalanx, there is no active flexion in both interphalangeal joints (Fig. 87). The study by these methods must be carried out carefully, since an attempt to strongly contract the muscle can contribute to the formation of a significant diastasis between the ends of the damaged tendon.
Treatment.
If damage to the flexor tendons is suspected, patients are hospitalized in a specialized department. The ends of the tendons are sutured with special sutures using microsurgical techniques. The primary bandage should be applied with all fingers half-bent. After the operation, the hand is immobilized for 6 weeks.
Rehabilitation - 2 weeks.
Ability to work is restored after 2 months.
Flexor tendon injury at forearm level often accompanied by injury nerve trunks(median and ulnar nerves). If the tendons at the level of the palm and fingers are damaged, damage to the general digital or own nerves may occur. Therefore, sensitivity testing is mandatory. The operation can be performed under intraosseous or general anesthesia, depending on the extent of the intervention. The operation should be performed by a surgeon experienced in hand surgery, so in some cases it is advisable to postpone the operation, making only the primary surgical treatment wounds.
Extensor tendon injuries
The extensors are located on the hand and fingers under the skin, directly on the bone. Because of this, they can be damaged even with a slight cut of the skin. Often the tendons come off from the place of attachment to the bone of the nail and middle phalanges. It does this without damaging the skin. closed injury. After a tendon injury, finger extension is impaired. The goal of treatment is to restore lost function.
Most common damage. When the tendon is torn off from the nail phalanx, the latter ceases to fully unbend, and the finger takes on the appearance of a hammer. In the absence of treatment, hyperextension of the middle phalanx joins, and the finger takes on the appearance of a “swan neck”. In some cases, the tendon comes off with a bone fragment. In this case, the extension of the phalanx also falls out. A special splint is applied to fix the fingertip in extension. We usually splint if the injury is less than 3 weeks old for 6 weeks. If the damage occurred more than 3 weeks from the moment of contacting us, then - 8 weeks. During treatment, we recommend checking the splint and the position of the finger in it. When the tendon is torn from the middle phalanx, Boutonniere deformity develops (boutonniere deformity). In this case, flexion of the middle and hyperextension of the nail phalanx occurs (Fig. 3). We splint a finger for this type of injury for a period of 6-10 weeks. The specific fixation period is determined by many factors and is set individually for each patient.
Treatment.
With open injuries of the tendons, they need to be sutured. Subcutaneous tendon ruptures are usually treated conservatively. A special splint is placed on the finger, which allows you to bring the ends of the damaged tendon as close as possible. The fixing splint must be worn without removing the entire period determined for each level of damage. Otherwise, the tendon will not grow together and will not work effectively. Depending on the time elapsed since the injury, we lengthen the time of finger fixation.
