Name of the Procedure:

Repair of extensor tendon, distal insertion, primary or secondary; without graft (e.g., mallet finger)

Summary

This procedure involves repairing the extensor tendon at its point of insertion in the fingertip, typically without the use of a graft. This is commonly performed to treat mallet finger, whereby the tendon responsible for straightening the finger is damaged.

Purpose

The procedure addresses mallet finger, a condition where an injury to the extensor tendon results in the inability to straighten the fingertip. The goal is to restore normal function and appearance to the finger by repairing the damaged tendon.

Indications

• Visible deformity of the fingertip (drooping)
• Inability to straighten the fingertip
• Pain and swelling at the site of injury
• Patients diagnosed with mallet finger, either through physical examination or imaging studies

Preparation

• Follow doctor's instructions regarding fasting if anesthesia will be used.
• Discontinue certain medications as advised, such as blood thinners.
• Undergo preoperative imaging studies like an X-ray to assess the extent of tendon damage.

Procedure Description

1. Local or regional anesthesia is administered to numb the area.
2. An incision is made over the affected tendon at the fingertip.
3. The damaged tendon is located and repaired using sutures or other specialized techniques.
4. The skin is closed with stitches.
5. A splint or cast may be applied to immobilize the finger and allow proper healing.

Duration

The procedure typically takes about 30-60 minutes, depending on the complexity.

Setting

This procedure is usually performed in an outpatient clinic or surgical center.

Personnel

• Orthopedic surgeon or hand surgeon
• Surgical nurse
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Infection
• Bleeding
• Stiffness of the finger
• Incomplete healing of the tendon
• Need for additional surgeries if the tendon's function is not fully restored

Benefits

• Restoration of normal finger appearance
• Improved function and ability to straighten the finger
• Pain relief and reduction in swelling
• Benefits are typically realized within a few weeks to months after surgery

Recovery

• Keep the affected finger immobile and elevated.
• Follow wound care instructions and attend follow-up appointments.
• Physical therapy may be recommended to restore strength and flexibility.
• Expected recovery time ranges from several weeks to a few months, with varying degrees of activity restrictions based on individual progress.

Alternatives

• Non-surgical treatment such as splinting, though it may not be as effective for complete tendon rupture.
• Tendon grafting if a repair without a graft isn't feasible.
• Pros of alternatives: less invasive in the case of splinting.
• Cons of alternatives: may result in incomplete recovery of finger function or prolonged healing times.

Patient Experience

During the procedure, the patient will be under local or regional anesthesia, so they should not feel pain. Post-procedure, mild to moderate pain and discomfort are expected. Pain can be managed with prescribed medications. Patients may experience swelling and need to keep their finger immobilized for optimal healing.