Flexor Tendon Injuries in Pediatric Patients

Nietosvaara, Yrjänä; Lindfors, Nina; Palmu, Sauli; Rautakorpi, Sanna; Ristaniemi, Nadja

doi:10.1016/j.jhsa.2007.08.006

Cited by 61 publications

(56 citation statements)

References 25 publications

(56 reference statements)

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“…Some studies have shown no link between zone of injury and outcome (2,8), while another found that zone II injuries have worse outcomes (5). A third group studied 44 children with 58 injured digits and found that negative predictive factors include zone II injuries, multiple tendon involvement (FDS and FDP in the same digit), age younger than five years, immobilization longer than four weeks and below-elbow casting (indicating the requirement of above elbow casting) (19).…”

Section: Zone Of Injurymentioning

confidence: 99%

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Pediatric flexor tendon injuries: A 10-year outcome analysis

Sikora

Lai

Arneja

2013

Canadian Journal of Plastic Surgery

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BACkground: Primary flexor tendon repair was first introduced in the 1960s. Since then, major advances in the understanding of flexor tendon anatomy and biology have led to improved outcomes following repair. Relative to the adult population, sparse knowledge exists as to which operative and postoperative treatments are most successful in children. This is due, in part, to the rarity of pediatric tendon lacerations compared with the adult population, but also related to challenges when working with smaller anatomy and the decreased compliance in children with respect to rehabilitation protocols. Published reports indicate that the incidence of 'good' flexor tendon repair outcomes is as low as 53%. oBJECTIVE: To determine the injury pattern and demographics of pediatric flexor tendon injuries involving zones I, II and III over the past decade, and to report results and identify treatment paradigms that are associated with optimal outcomes. METhodS: A retrospective chart review of all flexor tendon injuries involving zones I, II and III between April 2001 and December 2010 was performed. Parameters reviewed included demographics, injury mechanism, repair technique, outcomes and complications. rESuLTS: A total of 47 patients with a median age of eight years experienced 100 tendon injuries. The most common cause of injury was glass (n=22), with the most common digit injured being the small finger (n=30). Tendon injuries included the following: flexor digitorum superficialis (n=46); flexor digitorum profundus (n=45), flexor pollicis longus (n=8); and adductor pollicis longus (n=1). Zone III had the highest number of injuries (n=47), followed by zone II (n=39). Ninety tendons were repaired using polyester suture, the most common size being 4-0. The modified Kessler technique was used in the majority of cases (n=62). Only 22 tendons underwent an epitendinous repair. Splint immobilization was used in 30 patients and a full cast in 17. The median duration of immobilization was four weeks. Forty-two patients underwent postoperative hand therapy. Using the American Society for Surgery of the Hand Total Active Motion (TAM) score, 40 of 47 patients experienced 100% recovery with no functional limitations. Two patients had a score <100%, not necessitating further surgery. A second operation was required for five patients. All patients in this group demonstrated 100% TAM at one year. ConCLuSIon: Pediatric flexor tendon injuries remain rare and usually involve the dominant hand holding or manipulating an object. An excellent outcome was found in 95.9% of patients assessed by TAM scores. Repair technique was chosen according to the size of tendon involved. Patients not treated with hand therapy and not immobilized in a cast were often too young to participate in rehabilitation. Based on the results, immobilization of young children for four weeks is safe and does not worsen functional outcomes. Of the patients requiring a second procedure, no predictive variables for poorer outcomes were found on analysis of age, outcome, cause,...

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Section: Zone Of Injurymentioning

confidence: 99%

“…A recent study found the incidence of flexor tendon injury in children to be 0.036 per 1000, with a peak incidence at three years of age (2). Glass and knife lacerations were the most common causes of injury (2). These injuries are severe and, if managed inadequately, can result in loss of hand function.…”

mentioning

confidence: 99%

Pediatric flexor tendon injuries: A 10-year outcome analysis

Sikora

Lai

Arneja

2013

Canadian Journal of Plastic Surgery

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“…12,16 The early active mobilization research, in comparison, focused age-related choices on surgical repair choices and number of strands. 17 Despite previous research suggesting no difference in rehabilitative outcomes, 13e15 the more recent studies indicating greater than 90% good and excellent results with early passive and active protocols provide promising evidence for consideration (Tables 1 and 2). 16,17 Confounding factors…”

Section: Early Active Mobilizationmentioning

confidence: 88%

“…13e15 Comparatively, more recent publications include high percentages of good and excellent results using early motion. 16,17 The purpose of this paper is to review the recommendations and research available to hand therapists pertaining to the rehabilitation of children following flexor tendon repair.…”

Section: Rehabilitative Optionsmentioning

confidence: 99%

Flexor tendon injuries in children: Rehabilitative options and confounding factors

Heyde

2015

Journal of Hand Therapy

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“…Thus, poor results may lead to disability and impaired development. Although most hand traumas are being taken care of at the emergency department or by a general practitioner, more serious injuries, like a flexor tendon injury (annual incidence 3.6 per 100.000 children [3]), usually caused by knife or glass lacerations [4][5][6] require a high competence care. One important factor for an impaired outcome is a delay in the diagnosis, whereas 25% of the flexor tendon injuries in children are missed at the initial examination [7].…”

Section: Introductionmentioning

confidence: 99%

Early mobilization compared with immobilization after repair of a flexor tendon injury in children: A retrospective long time follow-up

Birkisson¹,

Dahlin²,

Rosberg³

2017

Hand Microsurg

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Objectives: To investigate if early mobilization and immobilization regimes influence long-term outcome after repair of a flexor tendon injury in fingers in children. Methods: A retrospective follow-up study (2003)(2004)(2005)(2006)(2007)(2008)(2009) was conducted in 27 children (1-16 years) with a flexor tendon injury, excluding a flexor tendon injury in the thumb. Early mobilization (n=17) or immobilization (n=10) was used. Range of motion (ROM; expressed in % of contralateral uninjured hand) in MCP, PIP, and DIP joints was measured, grip strength was recorded, and VAS for function and cosmetic was evaluated. Results: No ruptures or infections were observed. In the early mobilization group there were more boys; they had a higher age, more transection injuries, and more concomitant digital nerve injuries. However, no differences between the early mobilization and the immobilization groups for functional or cosmetic VAS, ROM for MCP, PIP, and DIP joints or for grip strength were found. Conclusions: The long-term outcome after a flexor tendon repair does not differ between early mobilization in older children and immobilization in younger children, implying that an early rehabilitation program is not necessary in young children.

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Flexor Tendon Injuries in Pediatric Patients

Cited by 61 publications

References 25 publications

Pediatric flexor tendon injuries: A 10-year outcome analysis

Pediatric flexor tendon injuries: A 10-year outcome analysis

Flexor tendon injuries in children: Rehabilitative options and confounding factors

Early mobilization compared with immobilization after repair of a flexor tendon injury in children: A retrospective long time follow-up

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