Flexor Tendon Injury of the Hand in Children: A Long-term Follow-up Study of 84 Patients

Abstract

The treatment series comprised 96 children with flexor tendon injuries of the hand. Sixty-one per cent of the injuries were in no-man's land. About one half of the patients had tendon severances of the little or ring fingers. The flexor tendon was sutured in 57 hands (59%) and grafted in 37 hands (39%). Tendon transposition was performed in two hands (2%). A total of 84 children were reexamined after a mean follow-up of 8.5 years. Of 53 hands in which direct tendon sutures had been done, either as a primary, delayed or late procedure, results were good in 46 (86.8%), fair in five (9.4%) and poor in two (3.8%). Of 30 free tendon grafts performed on 29 patients, results were good in 14 fingers (46.7%), fair in 10 (33.3%) and poor in six (20%). We recommend primary suture of a divided profundus tendon at any level. A cut superficialis tendon in no-man's land should be excised, if the surgeon is not a skilled hand surgeon. In our experience suture of the flexor tendon, performed at any level, gives better results than grafting.

Flexor Tendon Injuries in Pediatric Patients

“…The rates and lengths of delay in treatment in this study were similar to the recent series of Elhassan et al 5 Considerably higher rates of delayed treatment occurred during the 1980s (30%) 3 and during the 1970s, when only 59% of flexor tendon disruptions in children were amenable to direct repair by primary, delayed, or late procedures in Helsinki. 20 Our preference with an active motion program was to use 6-strand core sutures in zone 1 and 2 repairs in adolescents and 4-strand core sutures in zone 5 injuries and in younger children. Tendons that were repaired with single Kessler sutures were immobilized.…”

Surgical Outcome of One-stage and Two-stage Flexor Tendon Grafting in Children

“…It was therefore predictable to find poor results for 2-stage flexor tendon reconstruction in both the adult and pediatric series reported in the literature. 2,5,9,12 However, secondary flexor tendon surgery provides worse clinical results for an equivalent lesion in children than in adults. 9 Several investigators maintain that age under 6 years is associated with worse results than in older patients.…”

An Analysis of Factors Associated With Failure of Tendon Repair in the Canine Model

“…This issue is well recognized in the pediatric population, and many surgeons recommend immobilization after repair in very young children. [52][53][54] Although in adult humans controlled loading can be achieved by patient education and careful supervision of the rehabilitation regimen, even in adults uncontrolled loading may occur accidentally, as in a fall or simply by misjudging the effort needed in routine activities of daily living, such as donning clothing. In addition, many human flexor tendon lacerations occur in the context of physical altercations and drug or alcohol abuse, which may reoccur in the postoperative period.…”