BACKGROUND: Pediatric tendon injuries are rare but are associated with serious complications, such as permanent limb dysfunction, if not diagnosed and treated properly. However, there is a lack of data on their epidemiology and management in the emergency department (ED). The present study describes the characteristics and management of pediatric hand- and foot-tendon injuries in a Japanese pediatric ED. METHODS: The present, retrospective, observational study, conducted from March, 2010 to March, 2023, enrolled children younger than 16 years who received a diagnosis of a tendon injury to the hands or feet at a pediatric ED in Tokyo Metropolitan Children's Medical Center. Visits to the ED for follow-up examinations were excluded. The patients' sex, age, arrival time, mechanism of injury, signs and symptoms, examinations, diagnoses, outcomes, and complications were extracted from their medical records. RESULTS: Forty-two tendon injuries in 26 patients were included. Fifteen patients (58%) were male, and the median age was 9.5 years. Injuries occurred most frequently at home (58%) and most often involved a sharp object (42%). The median wound size was 2 cm. Tendon exposure occurred in 38% of patients and limited range of motion occurred in 83%. Tests performed in the ED included plain radiograph (100%) and ultrasonography (12%). Fracture complications occurred in three patients and nerve injury occurred in five. Orthopedic complications occurred in 15 patients (58%). CONCLUSIONS: Pediatric hand and foot-tendon injuries had a high risk of orthopedic complications and characteristic features included large wound size, tendon exposure, and limited range of motion.