Cuts to the dorsum of the...

Hand or foot are often underestimated.  After all, there's not much there; so as long as there's no fracture we can just clean and close, no?  Consider a case where a man drops a heavy ceramic item onto his foot and sustains a laceration.  Not unlike this one:

And this is his X-ray.  What must we consider before we close, and what actions do we take?

The x-ray shows a drooping big toe. The EHL tendon has been severed and will need operative repair. On this occasion the damage to deep structures was missed on first presentation.

Extensor tendons on the back of the hand or foot are extremely vulnerable to injury from any kind of incised wound. Functional assessment may reveal a defecit, however function can be preserved in partial tendon injury. It is therefore vital that these wounds are explored under local anaesthetic and the tendon inspected throughout the full range of movement. The classic example of this is the punching injury – the injury at the knuckle happens with a closed fist. With the fingers straightened in the ED, the injured part of the tendon may have moved proximally and the tendon at the base of the skin wound may look normal.

In this trust tendon injuries in the foot are admitted under the orthopaedic surgeons. Antibiotics and tetanus should be considered, the skin may be closed in ED pending definitive repair and the hand / foot should be splinted.

An overview of extensor tendon injury in the hand can be found here.

The same principles apply in the foot.