The Aetiology of Acute Rupture of Flexor Tendon Repairs in Zones 1 and 2 of the Fingers During Early Mobilization

Abstract

Five hundred and eight patients with 840 acute complete flexor tendon injuries in 605 fingers in zones 1 and 2 underwent surgery and postoperative mobilization in a controlled or early active motion (active flexion-active extension) regimen over a period of 7.5 years. Sixty-eight patients with 79 finger flexor divisions who did not complete the rehabilitation programme were excluded. Of the 440 patients with 728 complete tendon divisions in 526 fingers included in the study, 23 patients ruptured 28 tendon repair(s) in 23 fingers, an overall rupture rate of 4%. One hundred and twenty-nine fingers with zone 1 injuries had a rupture rate of 5%. Three hundred and ninety-seven fingers with zone 2 injuries had a rupture rate of 4%. This study analyses the 23 patients with flexor tendon rupture(s) to identify causative factors. In approximately half of these patients, tendon rupture followed acts of stupidity. The implications of this are discussed. There was no significant relationship between tendon rupture and the age or sex of the patients, smoking or delay between injury and tendon repair and there was no particular prevalence of zone 2C level injuries among the fingers in which tendon rupture occurred.

Clinical Outcomes Associated with Flexor Tendon Repair

“…These actions impose a sudden increase in the force transmitted through the repaired tendons and may subject tendons to a higher risk for ruptures. (5) Misuse of the fingers: analysis of the causes of ruptures in previous reports indicates that in approximately half of patients with ruptures, the rupture followed an ill-advised action [19,27]. Misuse of the repaired fingers, such as using the hand to lift a heavy object, may exceed the repair strength of the tendon and cause rupture.…”

“…Overall results by Strickland and Glogovac criteria were 92% excellent or good, 7% fair, and 1% poor. There were 43 complications in 31 patients, including five zone II ruptures (5.7%) and one rupture in zone V. Harris et al [27] reviewed results of 440 patients with 728 primary zone I and zone II flexor tendon repairs in 526 fingers. Overall, 23 patients ruptured 28 tendon repairs.…”

Effects of repetitive injections of hyaluronic acid on peritendinous adhesions after flexor tendon repair: a preliminary randomized, placebo-controlled clinical trial

“…[4] However, early active mobilization protocols may increase the repair site elongation and rupture rates. [39,40] In order to solve these problems, many multi-strand tendon suture techniques have been described. [41,42] Experimental studies have shown that suture strength and resistance to repair site gap formation increase with the number of suture strands crossing the tendon repair site.…”

Modified Brunelli Pull-Out Technique in Flexor Tendon Repair for Zone II: A Study on 58 Cases

“…The general rupture rate after primary repair is considered to be between 4-10% of the fingers [20,28,31]. Talking only about primary flexor tendons in zone II and repaired with the Kessler and circumferential suture, most series report a rupture rate of between 3-9% [2,3,7,[9][10][11][12]15]. In only one series of 95 children, O'Connell et al [24] report a rupture rate of 0%.…”