Although seemingly simple in its anatomy and function, the extensor mechani
sm of the hand is actually a complex set of interlinked muscles, tendons, a
nd ligaments. A thorough understanding of the extensor anatomy is required
to understand the consequences of injury at various levels. Reconstructive
options must restore normal function. Whereas primary repair of anatomic st
ructures is frequently possible in acute injury, it is rarely possible in c
hronic situations. Technically exacting procedures may be necessary to rest
ore function.