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Pediatric Extensor Tendon Injuries of the Hand: Evaluating Incidence and Outcomes
Sara Mariam Amini, BS, Klarissa Bermudez, MS, Danielle-Aditi Raikar, MD; David D. Rivedal, MD
Medical College of Wisconsin, Wauwatosa, WI
Introduction: The true incidence of pediatric extensor tendon injuries is not well documented. These injuries commonly affect multiple anatomical zones and may present subtly, delaying diagnosis and increasing the risk of complications like extensor lag, joint stiffness, and tendon imbalance. This study aims to address this gap by reviewing nearly two decades of cases from a single, high-volume academic center, focusing on injury patterns and follow-up outcomes.
Methods: A single-center retrospective chart review was conducted on patients under 18 treated for upper extremity extensor tendon injuries between January 1, 2008, and December 31, 2023. Data collected included demographics, mechanism of injury, zone of injury, associated injuries, treatment, and range of motion outcomes. Follow-up was reviewed for complications, return to activity, and need for surgical revision.
Results: A total of 17 pediatric patients with extensor tendon injuries distal to the elbow were identified (mean age 12.9 years; 65% male; 76% right-hand dominant). Imaging studies revealed 41% of patients had a bony injury in addition to an extensor tendon injury. Injuries were most frequently located in Zones 1 and 3 (n=5 each) and Zone 5 (n=4), with fewer cases observed in Zones 2 and 4 (n=2 each) and Zone 7 (n=1).
Fifteen patients (88%) required surgical repair; 9 were performed in the emergency department, 7 in the operating room. Most common techniques included percutaneous pinning and non-absorbable suture repairs (e.g., 3-0 or 4-0 Ethibond). One patient required revision surgery; no other complications were reported.
At follow-up, 9 patients regained full range of motion, 4 had minor limitations but could perform daily activities, and 4 lacked follow-up data. The mean follow-up duration was 156.5 ± 282.2 days, with 16 patients (94%) receiving hand therapy.
Conclusion: Pediatric extensor tendon injuries of the upper extremity most commonly involve Zones 1, 3, and 5. Most extensor tendon repairs can be performed in the emergency department with favorable functional outcomes. Despite variability in injury type and zone, over half of patients regained full range of motion.
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