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Extensor Tendon Repair 26410

 
CPT Coding Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms:extensor tendon repair

 Extensor Tendon Repair CPT

Extensor Tendon Repair Indications

  • H

 Extensor Tendon Repair Contraindications

  •  

Extensor Tendon Repair Alternatives

  • A

Extensor Tendon Repair Pre-op Planning

  • A

Extensor Tendon Repair Technique

  • Zone 1 (DIP joint):running 5-0 Prolene suture supplemented by a transarticular Kirschner
    wire in full extension for 6 week
  • Zone 2 (middle phalanx): Running 5-0 suture near cut edge of tendon, reinforced with “basket-weave” or “Chinese
    fingertrap” type of cross-stitch on dorsal surface of the tendon
  • Zones 3 through 5 in fingers, and zones 2 and 3 in thumb: Modified Kessler core 4-0 suture, reinforced with 5-0 cross-stitch on the dorsal surface
  • Zones 6 and 7: Modified Kessler core 4-0 suture, reinforced with 5-0 cross-stitch run around the entire circumference of the
    tendon

Extensor Tendon Repair Complications

Extensor Tendon Repair Follow-up care

  • Zones 1 and 2: 6 weeks of immobilization with either splint or Kirschner wire fixation of the DIP joint
  • Zones 3 through 5: splint with the wrist in 40 degrees of extension, slight flexion at the MP joint, and extension at the PIP joints for 4 weeks.
  • Zones 6 and 7:  splint with the wrist in 40 degrees of extension, slight flexion at the MP joint, and extension at the PIP joints for 4 weeks. Allow full active motion at the IP joints. 
  • Consider Dynamic splinting (passive joint extension with a dynamic outrigger device, with
    flexion limited by palmar splint), Controlled active mobilization (active joint extension, limiting joint flexion with a palmar splint).  Dynamic provides better short term outcomes but is equivalent to static splinting at 6 months. (Mowlavi A, Plast Reconstr Surg2005; 115:482-487)

Extensor Tendon Repair Outcomes

  • Patients without associated injury = 64% achieved good or excellent results; With associated injury =45% good or excellent results. More fingers loose ability to flex fully than ability to extend fully.   Injuries in zones 1 through 4 have a worse outcome than injuries in the more proximal zones. (Newport ML, J Hand Surg [Am] 1990;15:961-966)

Extensor Tendon Repair Review References