What is the treatment for extensor tendon central slip injury?

From the Guidelines

The treatment for an extensor central slip injury typically involves immobilization of the proximal interphalangeal (PIP) joint in full extension for 6-8 weeks. This approach is crucial for preventing complications such as boutonnière deformity, which can result from delayed or inadequate treatment 1. The immobilization is best accomplished using a dorsal extension splint that keeps the PIP joint at 0 degrees while allowing the distal interphalangeal (DIP) joint to move freely. For acute injuries without complete rupture, conservative management with splinting is the primary approach, with the splint worn continuously during the initial healing phase and gradual weaning after 6 weeks based on clinical improvement. Key aspects of treatment include:

• Immobilization of the PIP joint in full extension
• Use of a dorsal extension splint
• Allowing free movement of the DIP joint
• Continuous splint wear during the initial healing phase
• Gradual weaning of the splint after 6 weeks
• Physical therapy following immobilization to restore range of motion and strength, typically lasting 4-6 weeks. In cases of complete ruptures or injuries that do not respond to conservative management, surgical repair may be necessary, involving direct repair of the central slip to its insertion on the middle phalanx 1. Prompt treatment is essential to prevent long-term morbidity and maintain quality of life, as delayed management can lead to significant functional impairment.

From the Research

Treatment Options for Extensor Tendon Central Slip Injury

The treatment for extensor tendon central slip injury can vary depending on the severity and location of the injury.

• For acute closed central slip injuries, the treatment can be nonoperative by splinting if there are nondisplaced avulsions of the central slip insertion or lacerations 2.
• However, for displaced avulsions and complex injuries, the treatment is surgical, which may involve wound revision with extensor tendon suture or refixation of the central slip 2.
• In cases where the injury is overlooked, a typical deformity (buttonhole/Boutonnière deformity) may develop, and the treatment may involve reconstructive techniques to restore the extensor function 2.
• The choice of treatment also depends on the zone of injury, with different zones requiring different treatment approaches 3, 4.
• For example, zone III injuries, which involve the central slip, can be treated with closed extension splinting or surgical repair depending on the severity of the injury 3, 4.
• Early dynamic splinting has also been shown to be effective in preventing limitation of flexion and promoting full active flexion after extensor tendon repair 5.
• A study on the results of treatment for isolated zone 3 extensor tendon injuries found that primary tendon repair combined with the short arc motion protocol provided good results in terms of PIP joint motion and extension loss 6.

Surgical Techniques

Surgical techniques for extensor tendon central slip injury may involve:

• Modified Kessler and epitendinous sutures 6
• Locking running suture 6
• Mattress sutures of the tractus intermedius 3
• Reconstruction of the central slip and the lateral slip of extensor tendon using modified Becker sutures and mattress sutures 3
• Core sutures using modified Kirchmayr techniques with additional epitendinous suture 3

Postoperative Care

Postoperative care for extensor tendon central slip injury may involve:

• Immobilization of the finger for 6 weeks with removal of the transarticular wire at 4 weeks 3
• Dynamic postoperative treatment in intrinsic-plus splint for 6 weeks 3
• Early protected motion to prevent stiffness and promote full active flexion 5