Purpose <p>Extensor tendon injuries (ETI) are common. Injuries which involve more than half of the tendon width should be repaired. We aimed to compare the results of ETI repairs performed upon presentation in an emergency department (ED) minor procedure room (MPR) to those performed in the operating room (OR).</p> Methods <p>A retrospective study comparing a cohort of consecutive patients treated for ETI in an OR between 2018 and 2023 to a cohort of consecutive patients treated for ETI in an ED MPR between 2019 and 2022 was reviewed. The demographics, mechanism and characteristics of injuries and results were compared. Files were reviewed for 90 days for postoperative complications.</p> Results <p>One hundred and thirteen patients (147 tendons) were treated in the OR and 179 patients (203 tendons) were treated in the ED MPR. Patients’ demographics and injury mechanism were similar. A higher rate of patients treated in the OR presented with complete tears. The zone of injury differed between groups, but zone V was most frequent in both. No intraoperative complications were encountered. Postoperative complication rates were alike, with 4.4% of patients from the OR cohort and 1.7% patients from the MPR cohort presenting with postoperative infection (<i>p</i> = 0.268). Patients treated in the OR had a longer delay for surgery, a longer length of stay and received more opioid prescriptions.</p> Conclusions <p>Extensor tendon repairs performed at an ED MPR have comparable outcomes to repairs performed in the OR. The ED MPR setting might reduce medical costs, and it is associated with a shorter length of stay.</p> Level of evidence <p>III.</p>