The most common management of open injuries of the extensor tendons in Zones III to V (PIP to MP joint) is tendon suturation and digit immobilisation in extension for 4 to 6 weeks. Dynamic splinting and early mobilisation has been already successfully tested in the treatment of extensor tendons injuries in Zones VI to VII. In the current study we performed a protocol, including strong suture technique of the lacerated extensor tendon in Zone III to IV in addition with early mobilisation. From 1999 until 2002, 23 lacerated extensor tendons (Zones III – V) in 22 patients were managed at the Orthopaedic Department of the Univercity of Ioannina. The mean age of the patients was 36 years old (14 – 70 years). The principle treatment has taken place at the emergency room and included suture of the lacerated central slip, using the Kessler-Tajima technique, plus continuous suture of the epitenon. Injuries of other structures (lateral bands, sagittal band, joint captule) were also managed by suturing. After a period of 5 days (Zone V) to 3 weeks (Zone III) of immobilisation in a static splint, injured digit mobilisation started using a dynamic extensor splint until the 5th week after injury. The mean follow up was 7 months (3–24 months). There have been no ruptures of the extensor mechanism nore permanent digit deformities. Minimal (until 30o) loss of MP flexion or DIP extension has been regarded in 5 patients. The grip strength has been affected in 4 patients, and the grip strength between the 1st and 2nd digit (“the key pinch strength”) has been affected in 12 patients, compared with the contralateral hand. No further operation for tenolysis has been necessary. Satisfactory results have been obtained, by early mobilisation using dynamic splinting, in the treatment of open injuries of extensor tendons in Zones III – IV under the following conditions: using strong suture technique, a co-operative patient and weekly examination of the patient. Using a dynamic splint only for the injured digit is better accepted by the patient.
