UMEM Educational Pearls

Category: Orthopedics

Title: Tendon Laceration

Keywords: Tendon, laceration (PubMed Search)

Posted: 5/7/2011 by Michael Bond, MD (Updated: 3/28/2024)
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Tendon Lacerations:

  • Flexor tendon lacerations have historically not been repaired by emergency providers due to the extensive pulley systems involved and possibility of loss of mobility from scarring.
    • However, if both ends of the tendon can be visualized in the ED it is not unreasonable to place 1 or 2 horizontal mattress sutures between the two ends to prevent retraction of the proximal portion which can make a formal repair more difficult.
  • Extensor tendon lacerations can be repaired by emergency providers.
    • One technique is to use a running horizontal mattress suture with non-absorbable nylon sutures. 
    • The ultimate strength of the repair is dependent on the number and size of the sutures placed.
    • Careful placement of the sutures can prevent gap formation between the ends when the tendon is stressed.

A reasonable approach to all tendon lacerations is to close the wound and splint in the hand in the position of function until the patient can be seen by a hand surgeon in the next 1-3 days.  These injuries do not require immediate surgical repair.

References