Full-size Left-side Hidden
Extensor Tendon Repair Protocol

Zone I: Terminal Tendon Laceration/Mallet Injury

0–2 Weeks Postoperative

      Fabricate thermoplastic extension splint for DIP joint only, at first visit
      Alternative splinting can be used (aluminum splint lined with moleskin to protect dorsal skin)
      DIP joint should be place in slight hyperextension, avoiding blanching of the skin
      Splint must allow full PIP joint flexion
      Educate patient regarding continuous splint use; if splint is removed for hygiene, DIP joint must be maintained passively in hyperextension at all times
      If open reduction/internal fixation has been performed, a thermoplastic clamshell splint can be used to protect fingertip
      Bony mallet deformities can be treated conservatively with plaster casting. Position of fracture fragment placement can be assessed via Fluoroscan to assess if cast should be extended beyond PIP joint into boutonnière position for 2 weeks.
      Edema reduction techniques, as needed

2–6 Weeks Postoperative

      Continue active PIP joint …