Zone II Flexor Tendon Repair in Children: A Retrospective Long Term Study

Abstract

Forty-three children with 46 lacerations of the flexor digitorum profundus tendon were evaluated at a mean of five and a half years (range three to 10) after tendon repair. Postoperatively, 27 digits were treated with early controlled mobilisation as described by Kleinert and 19 digits were immobilised in plaster. Thirty-one digits were primarily repaired within 24 hours, and in 15 digits repair was delayed. The return of total active motion (TAM) in the interphalangeal joints was evaluated with the Strickland formula, and the mean was 77%. TAM correlated with the age of the child at the time of injury. Variables such as postoperative regimen, concurrent injury to the superficial tendon or digital nerve, delayed tendon repair, localisation of injury in the fibro-osseous canal, and type of trauma, had no significant effect on the final result.

Factors That Influence the Outcome of Zone I and Zone II Flexor Tendon Repairs in Children

“…25 Similar results have been reported in other studies. 27 Berndtsson and Ejeskar 28 reported on the influence of postoperative mobilization protocol on the outcome of 46 zone II flexor tendon repairs in children younger than 16 years. They divided their patients into 2 groups.…”

Flexor Tendon Injuries in Pediatric Patients

“…In a study from Sweden, 13 of 43 patients (1-16 years of age) had a delay in treatment ranging from 3 weeks to 1 year. 3 In a study from Japan, 4 in children younger than 6 years, the time elapsed from injury to tendon repair varied from 0 to 42 days (mean 23 days), and a recent report from North America 5 indicated that 6 of 41 fingers had a delayed repair performed at 2 to 9 weeks after the injury.…”

“…1 The most common mechanism of finger flexor tendon disruptions reported in children is cut by glass, with zone 2 tendon lacerations comprising 36 -60% of all injuries. [2][3][4] Diagnosis of flexor tendon injuries in children is not always easy, and patient-or doctor-related delays in treatment are not uncommon. In a study from Sweden, 13 of 43 patients (1-16 years of age) had a delay in treatment ranging from 3 weeks to 1 year.…”

“…Most authors have used different types of 2-strand braided or monofilament nonabsorbable core sutures combined with a running or interrupted epitendinous suture. 1,3,4,6,7 Four-strand core sutures have been used in flexor digitorum profundus repairs in zone 2 injuries, depending on the size of the tendon. 5 In a combined study of 3 hand surgery practices, 6 no difference in outcomes after different tendon repair technique or suture material was observed.…”

Pediatric flexor tendon injuries: A 10-year outcome analysis

“…Rehabilitation protocols, such as the Kleinert, are beneficial in children older than six years of age, but these protocols are difficult to use in younger children (1,2,6). Some studies claim that protocols are not necessary in children younger than six years of age, and that only immobilization is required (5,7). Others have shown that immobilization for longer than four weeks causes functional decline (8,9).…”