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Extensor Tendon Lacerations: Zone III (PIP joint)

- See: Extensor Tedon Lacerations

- Discussion:
    - tendon laceration is usually transverse w/ minimal retraction;
    - often extends into the PIP joint;
    - lateral bands are often spared, but may be subluxed volarly due to disruption of the triangular ligament;
    - left untreated, a boutonniere injury may develop;

- Technique of Repair:
    - skin laceration can be extended w/ a curvilinear incision distally or proximally;
    - tendon can be repaired w/ figure of eight 4-0 Ethibond sutures, but take care to avoid tendon shortening;
           - because the tendon is thin in this region, a Bunnel weave may not be possible;
    - if central slip has been disrupted then consider splitting the lateral bands longitudinally for 2 cm and suturing them together in the midline, which will re-create a functional central slip;
           - the latearal bands initially need to freed from their attachements to the oblique and transverse retinacular bands;
    - chronic injury:
           - in a chronic injury, the central slip may be scarred down, and in this case, the entire width of the central slip needs to be dissected out and mobilized proximal to the lateral bands;
                  - the central slip can then be opposed to its normal insertion;
                  - subsequently the lateral bands can be reattached to the central slip, just proximal to the PIP joint, which prevents then from acting as PIP flexors;
           - if the lateral bands are held down by the transverse retinacular ligament, the later should be released to allow free up the lateral bands;

- Post Op:
    - as w/ boutonniere injury, there needs to be 5-6 weeks of splinting in extension before ROM is permitted;
    - main complication of this injury is extensor lag

Results of acute zone III extensor tendon injuries treated with dynamic splinting.