How current extensor tendon repair practices differ from expert recommendations

Introduction: This study aimed to understand the current real-world status of extensor tendon repairs with data through an international survey, thus providing information to guide continuing education, design of courses and global standardization efforts. Methods: Ten hand surgeons were surveyed from each of five countries in America, Asia and Europe. The survey participants – all practising hand surgeons – were asked to answer multiple choice questions regarding their extensor tendon repair surgery and therapy. Results: The survey revealed remarkable discrepancies or ‘distances’ between the real-world practice and the current recommended guidelines with differences across continents. Major findings are (1) relative motion splinting is used by less than half of the surveyed colleagues for closed boutonniere deformity, while static splinting remains more common; (2) strong repair techniques are less commonly used in extensor digitorum communis tendon repair, the survey highlighting a substantial gap between current practice and recommended standards of strong surgical repair; and (3) early active motion has not been commonly used after extensor tendon repair. Discussion: Although principles of tendon surgery such as strong repair and early active motion are well established in past decades, they are not often applied to the extensor tendons. The survey data indicates that current practices are lagging behind current expert recommendations. This report provides a clearer picture of real-world extensor tendon repair practices, which may help design and inspire more targeted continuing education and identify the weak areas or deficits in knowledge and technique updates and training in extensor tendon repairs across continents.