Neglected extensor apparatus injury in the proximal interphalangeal joint

Rationale: The extensor tendon of the proximal interphalangeal (PIP) joint is highly complex, and failure to ensure suitable balance during treatment following an injury is likely to produce poor outcomes. We have achieved good outcomes with the primary repair of neglected extensor tendon rupture in the PIP joint, and thus report the case along with a review of the relevant literature. Patients concern: A 40-year-old right-handed female who works at a meat shop visited our clinic due to pain and active limitation of the range of motion (ROM) of the PIP joint of her left long finger. She had previously experienced a cut on the dorsal aspect of the third PIP joint while cutting meat about a year earlier but did not receive any specific treatment for the injury. Diagnosis: The patient was diagnosed with complete rupture of the central slip and lateral band in the PIP joint after investigation. Intervention: We successfully debrided the ruptured tendon and performed extensor tendon repair using the modified Kessler technique and epitendinous cross-over repair technique. Outcome: At the 12-month follow-up, the patient was completely asymptomatic and had optimal PIP joint ROM (0°–90°) in her left long finger. Lessons: Although the treatment of an extensor injury of the PIP joint area is difficult, satisfactory outcomes can still be achieved, even in cases of injuries which are neglected for over a year, using a repair technique that can properly balance the length and tension between the central slip and lateral bands with the selection of appropriate postoperative treatment strategies.