From the Research
Untreated extensor tendon lacerations of the third digit in pediatric patients can lead to significant complications, including permanent extension deficit, flexion deformity, joint contractures, and functional limitations, emphasizing the importance of early surgical repair. The primary complication is permanent extension deficit, where the child develops an inability to fully extend the toe, resulting in a flexion deformity known as "hammer toe" or "claw toe" 1. This occurs because the unopposed action of the flexor tendons gradually pulls the toe into a flexed position. Over time, this abnormal positioning can lead to joint contractures, where the toe becomes fixed in the deformed position, making later correction more difficult and potentially requiring more invasive surgical intervention. Children may develop compensatory gait abnormalities as they try to avoid pain or accommodate the toe deformity, which can lead to secondary issues in the ankle, knee, hip, or lower back. The abnormal toe position can also cause painful calluses or pressure points where the toe rubs against footwear, potentially leading to skin breakdown or ulceration in severe cases. Additionally, children may experience functional limitations in activities requiring foot dexterity or balance.
Early surgical repair is crucial, as it provides the best outcomes, with studies suggesting that immediate open traumatic extensor tendon repair can be safely performed in an emergency department minor procedure room under local anesthesia, with a low post-operative infection rate of 1.4% 2. The use of a single relative motion with dorsal hood orthosis and a modified short arc motion protocol has also been shown to be effective in treating zone III extensor tendon injuries, allowing for full range of motion, strength, and function to be regained 3.
Key considerations in the management of extensor tendon lacerations include:
- Early surgical repair within 7-10 days of injury
- The use of appropriate orthoses and rehabilitation protocols to minimize adhesion formation and promote optimal healing
- The potential for complications, such as joint contractures and functional limitations, if left untreated or if treatment is delayed. It is essential to prioritize early intervention to prevent long-term morbidity and mortality, and to improve the quality of life for pediatric patients with extensor tendon lacerations 4.