Injuries to the flexor tendons have always received greater attention due to their complexity and their relationship with the osteofibrous tunnel, even though they are less common and of equivalent importance to those of the extensor tendons.

The objective is to evaluate the functional outcomes in the repair of traumatic extensor tendon injuries of the fingers.

The selected patients had traumatic extensor tendon injuries in Verdan's zones IV to VI from March 2021 to November 2022 and underwent tenorrhaphy using the WALANT (Wide Awake Local Anesthesia No Tourniquet) technique to assess intraoperative suture tension. In the postoperative period, they followed a rehabilitation protocol based on early movement, with immobilization using a plaster bandage. Final functional outcomes were evaluated 3 months after surgery using the Miller and Dargan scores.

The study included 37 patients, 29 men (78.4%) and 8 women (21.6%), with a mean age of 33.9±4.0 years. The time from injury to surgery was 9.6±2.0 days. The most affected finger was the middle finger (59.5% of cases), followed by the index finger (40.5%). The lesion zone with the highest number of occurrences was Verdan's zone V. Most patients had excellent results for finger extension and flexion. Patients with multiple fingers affected had worse functional outcomes on Dargan scores for loss of final extension. All patients with tendon suture rupture during intraoperative evaluation had excellent functional outcomes, and no patient had poor results on either evaluated score. Three patients experienced postoperative complications.

When analyzing the final functional results after repair of the extensor tendons rehabilitated with the aid of a dynamic orthosis, we found results classified as excellent according to the Miller score for extension and flexion of the fingers. We emphasize the importance of the wrist extension position at 30 degrees and the metacarpophalangeal joints at 15 to 20 degrees of the repaired finger(s) Furthermore, the extension position prevents the unloading of force on the repaired tendon. Intraoperatively, the maximum tension of the suture can be observed without the formation of spacing between the repaired tendon stumps, which makes it possible to redo the suture if necessary.

Surgical repair of extensor tendon injuries in zones IV to VI treated with early rehabilitation yields good final functional results. The WALANT anesthetic technique allows direct visualization of suture tension during intraoperative active movement, thereby reducing the rate of postoperative complications.