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Repair of partial lacerations of the extensor tendons of the hand
  1. Martin Smith,
  2. Bruce Martin
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL

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    Report by Martin Smith, Specialist Registrar Search checked by Bruce Martin, Clinical Fellow

    Clinical scenario

    A 24 year old man is brought into the emergency department having sustained a laceration over the dorsal aspect of the metacarpophalangeal joint of the left index finger. You explore the wound and find that there is a 50% laceration of the extensor tendon. You wonder whether this requires repair.

    Three part question

    In [patients with partial extensor tendon lacerations] does [surgical repair or conservative management] result in [the quickest and fullest recovery]?

    Search strategy

    Medline 1966–03/00 using the OVID interface. [({exp tendon injuries OR tendon injuries.mp OR exp tendons OR extensor tendon$.mp OR partial tendon laceration$.mp} AND {extensor$ OR dorsal$}) AND {exp casts, surgical OR exp splints OR splint$.mp OR exp surgical procedures, operative OR exp suture techniques OR conservative treatment$.mp OR surgical repair$.mp OR tendon repair.mp}] AND maximally sensitive RCT filter LIMIT to human AND english.

    Search outcome

    Altogether 141 papers were found of which none were relevant.

    Comments

    There is no direct evidence that can assist in answering this question. The trials of partial tendon repair that have been reported all involved flexor tendons. These results cannot be extrapolated to the extensor tendon.

    Clinical bottom line

    Local advice should be followed.

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