SPLINTING FLEXOR TENDON INJURIES

Hand Surgery ◽  
2002 ◽  
Vol 07 (01) ◽  
pp. 101-108 ◽  
Author(s):  
Elaine Ewing Fess
Keyword(s):  
Classification System ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Flexor Tendon Injuries ◽  
Early Passive

Frequently used zone 2 flexor tendon repair splints are reviewed and classified according to the Amercian Society of Hand Therapists' Splint Classification System. These splints both restrict and mobilise digital motion and fall into two main groups: (1) splints that incorporate the wrist and digital joints as primary joints to allow predetermined increments of early passive or active motion at both the wrist and digital joints; and (2) splints that include the wrist as a secondary joint and the digital joints as primary joints, allowing early passive or active motion at digital joints but not at the wrist.

Evaluation of flexor tendon repair (zone II) with Wide Awake Anesthesia

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Adel Zaghloul Fayed ◽  
Naglaa Mohamed Abdel Aziz ◽  
Ebrahim Mohamed Amin Abdel Gawad ◽  
Ibrahim Hussien Kamel ◽  
Ahmed Elshahat
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Rehabilitation Protocol ◽  
Flexor Tendon Injuries ◽  
Zone Ii ◽  
Active Rehabilitation ◽  
Wide Awake

Abstract Background Recent advances in hand surgery has been the movement away from tourniquet surgery, which often requires sedation or GA and the patient will be awake and cooperative. Wide awake approach depends on the safety of adrenaline which is now well established. This review will evaluate the role of the wide awake approach in reducing rupture and tenolysis rate after flexor tendon repair zone 2. Objective To evaluate the functional outcome of flexor tendon repair zone II (most challengeable) under wide awake anesthesia. Patients and Methods After approval of local ethical committee of faculty of medicine Ain Shams University, this Prospective study has been conducted targeting patients with acute zone II flexor tendon injuries admitted at El Sahel Teaching Hospital within the period from September 2019 till January 2020, and their follow up for minimum three months at outpatient clinic. A Written informed consent explaining the whole procedure under study in this research has been obtained from all patients and absolute confidentiality as regard the patients’ names and addresses was given special care and attention. Final outcome evaluated by Original Strickland evaluation system. Results Using the wide awake technique provides an optimal opportunity to test repair strength through Intra-operative Total Active Movement (ITAM) making the surgeon much more comfortable to initiate early active motion. Besides, rising trend toward using early active rehabilitation protocol in case of strong repair using four or more strands repairs is recently supported in literature. This study adopted early active rehabilitation protocol with slight differences among them Conclusion This preliminary study assessing the outcomes of primary tendon repair in flexor tendon injuries in zone II using the wide-awake technique demonstrates encouraging results, being satisfactory for both surgeons and patients that makes this new approach a competitive to the other approaches of flexor tendon repair implemented under conventional methods of anesthesia.

Flexor Tendon Repair in Zone 2 Followed by Controlled Active Mobilisation

1989 ◽  
Vol 14 (4) ◽  
pp. 392-395
Author(s):  
K. W. CULLEN ◽  
PAMELA TOLHURST ◽  
D. LANG ◽  
R. E. PAGE
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Adult Patients ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Injuries

Over a two-year-period, 34 adult patients who had suffered zone two flexor tendon injuries to 38 fingers (70 tendons) were managed post-operatively by a regime of early active mobilisation. The results of this technique, assessed by the Strickland criteria after a mean follow-up period of 10.2 months, compared favourably with other more cumbersome methods.

Results of heterodigital flexor digitorum profundus hemi-tendon transfer for 23 flexor tendon injuries in zones 1 or 2

2017 ◽  
Vol 43 (5) ◽  
pp. 487-493 ◽  
Author(s):  
Aude Bommier ◽  
Duncan McGuire ◽  
Patrick Boyer ◽  
Asan Rafee ◽  
Sami Razali ◽  
...  
Keyword(s):  
Tendon Transfer ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Active Motion ◽  
Flexor Tendon Injuries ◽  
Flexor Digitorum

We report outcomes of reconstruction of zone 1 or 2 flexor tendon injuries using a heterodigital hemi-tendon transfer of the flexor digitorum profundus in 23 fingers of 23 patients. At mean follow-up of 57 months, the mean total active motion of the three finger joints including the metacarpophalangeal joint was 128 degrees preoperatively and 229 degrees at final follow up. According to Strickland criteria, the function was excellent for 14 fingers, good for seven fingers and poor for two fingers. The subgroup analysis showed that the results were better in cases of primary surgery, children, and for the index and little fingers. Complications included stiffness of three fingers, and rupture in one finger that was converted to a two-stage tendon reconstruction. We conclude that this technique restores good function in most patients with zone 1 and 2 flexor tendon injuries, in which primary tendon repair has not been performed or was unsuccessful, and where pulley reconstruction is not required. Level of evidence: IV

scholarly journals An Overview of the Management of Flexor Tendon Injuries

2012 ◽  
Vol 6 (1) ◽  
pp. 28-35 ◽  
Author(s):  
M Griffin ◽  
S Hindocha ◽  
D Jordan ◽  
M Saleh ◽  
W Khan
Keyword(s):  
Flexor Tendon ◽  
Current Knowledge ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Tendon Injury ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Injury ◽  
Post Surgery ◽  
Flexor Tendon Injuries

Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. Since the first flexor tendon repair was described by Kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 70-90%. Primary surgical repair results in better functional outcome compared to secondary repair or tendon graft surgery. Flexor tendon injury repair has been extensively researched and the literature demonstrates successful repair requires minimal gapping at the repair site or interference with tendon vascularity, secure suture knots, smooth junction of tendon end and having sufficient strength for healing. However, the exact surgical approach to achieve success being currently used among surgeons is still controversial. Therefore, this review aims to discuss the results of studies demonstrating the current knowledge regarding the optimal approach for flexor tendon repair. Post-operative rehabilitation for flexor tendon surgery is another area, which has caused extensive debate in hand surgery. The trend to more active mobilisation protocols seems to be favoured but further study in this area is needed to find the protocol, which achieves function and gliding but avoids rupture of the tendons. Lastly despite success following surgery complications commonly still occur post surgery, including adhesion formation, tendon rupture and stiffness of the joints. Therefore, this review aims to discuss the appropriate management of these difficulties post surgery. New techniques in management of flexor tendon will also be discussed including external laser devices, addition of growth factors and cytokines.

Flexor tendon injuries in the child

2013 ◽  
Vol 39 (1) ◽  
pp. 46-53 ◽  
Author(s):  
M. M. Al-Qattan
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Skin Closure ◽  
Two Stage ◽  
Flexor Tendon Repair ◽  
Technical Aspects ◽  
Tendon Reconstruction ◽  
Flexor Tendons ◽  
Flexor Tendon Injuries

This review aims to highlight the differences in the management of flexor tendon injuries between children and adults. These include differences in epidemiology, anatomy, classification, diagnosis, incisions and skin closure, the size of the flexor tendons, technical aspects of zones I and II repairs, core suture purchase length, rehabilitation, results, and complications of primary flexor tendon repair. Finally, one- versus two-stage flexor tendon reconstruction in children is reviewed.

Flexor Tendon Injuries in Children

1994 ◽  
Vol 19 (6) ◽  
pp. 696-698 ◽  
Author(s):  
A. O. GROBBELAAR ◽  
D. A. HUDSON
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Flexor Tendons ◽  
Ulnar Nerve Palsy ◽  
Flexor Tendon Injuries ◽  
Rapid Healing ◽  
Tendon Ruptures ◽  
Better Than

Flexor tendon injuries in adults differ from those in children. 38 children (22 male and 16 female) with a mean age of 6.7 years were treated for flexor tendon injuries by primary suture and controlled mobilization between 1985 and 1992. 53 flexor tendons were injured (average 1.5 digits per patient) and the injury most commonly affected the little finger (23 patients). 60% of injuries occurred in zone 2. Using Lister’s criteria, 82% achieved excellent or good results. Repair of both FDS and FDP was better than repair of FDP alone, even in zone 2. There were three tendon ruptures (all classified as poor results) and one other poor result occurred in a zone 2 injury with an associated ulnar nerve palsy. The outcome after flexor tendon repair in children is better than in adults in our hands because rapid healing of tendons occurs in children. No child has yet required tenolysis because in children adhesions are more pliable. Both flexor tendons should be repaired irrespective of the zone of injury. A functional hand can be expected after flexor tendon repair in children.

MANAGEMENT OF FLEXOR TENDON INJURIES — PART 2: CURRENT PRACTICE IN AUSTRALIA AND GUIDELINES FOR TRAINING YOUNG SURGEONS

Hand Surgery ◽  
2014 ◽  
Vol 19 (02) ◽  
pp. 305-310 ◽  
Author(s):  
Sarah K. Tolerton ◽  
Richard D. Lawson ◽  
Michael A. Tonkin
Keyword(s):  
New Jersey ◽  
Current Practice ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Active Motion ◽  
Polyester Suture ◽  
Active Flexion ◽  
Flexor Tendon Injuries ◽  
Materials Used

Introduction: This study aims to gain a better understanding of current practice for the surgical management and rehabilitation of flexor tendon injuries in Australia, with the intent of establishing common guidelines for training of young surgeons. Methods: A survey was distributed to the membership of the Australian Hand Surgery Society to determine whether a consensus could be obtained for: suture material and gauge; core and epitenon suture techniques; sheath and pulley management; and post-operative protocols for primary flexor tendon repair. Results: The predominant materials used for core suture are TicronTM Suture (Tyco Healthcare Group LP, Norwalk, Connecticut, USA) (34%) and EthibondTM Polyester Suture (Ethicon, Somerville, New Jersey, USA) (24%). The two core suture configurations commonly used are the Adelaide (45%) and Kessler (32%) repair. The predominant materials used for epitendinous sutures are 6-0 ProleneTM Polypropylene Suture (Ethicon, Somerville, New Jersey, USA) (56%), 5-0 ProleneTM (21%) and 6-0 EthilonTM Nylon Suture (Ethicon, Somerville, New Jersey, USA) (13%); and the majority (63%) use a running epitendinous technique. The management of critical pulleys is variable, with 89% prepared to perform some release of A2 and A4 pulleys. Rehabilitation protocols vary widely, with 24% of respondents using the same method for all patients, while 76% tailor their approach to each patient. Some component of active motion was used by most. Discussion: There exists some consensus on the management of flexor tendon injuries in Australia. However, the management of critical pulleys and methods of post-operative rehabilitation remain varied. For the training of young surgeons, a majority advise a 3-0 gauge braided polyester core suture of four strands, combined with a 6-0 ProleneTM simple running epitendinous suture for increased tendon repair strength and smooth glide. Trainees should attempt to retain the integrity of the A2 and A4 pulleys. Post-operative rehabilitation should include a component of active flexion.

Primary Flexor Tendon Repair in Zones 1 and 2: Early Passive Mobilization Versus Controlled Active Motion

2014 ◽  
Vol 39 (7) ◽  
pp. 1344-1350 ◽  
Author(s):  
Florian Samuel Frueh ◽  
Viviane Sylvie Kunz ◽  
Isaac Joseph Gravestock ◽  
Leonhard Held ◽  
Mathias Haefeli ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Passive Mobilization ◽  
Early Passive

scholarly journals An analysis of the effect of the technique of the repair and postoperative rehabilitation protocol on the treatment outcomes of flexor tendon injuries: a review

2020 ◽  
Vol 66 (3) ◽  
Author(s):  
Andrzej Żyluk ◽  
Bernard Piotuch
Keyword(s):  
Treatment Outcomes ◽  
Flexor Tendon ◽  
Scientific Evidence ◽  
Tendon Repair ◽  
Conclusive Evidence ◽  
Tendon Injuries ◽  
Flexor Tendon Repair ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
Flexor Tendon Injuries

This study covers updated information on the methods of the repair of flexor tendon injuries, postoperative rehabilitation protocols and their effect on treatment outcomes. Contemporary techniques of flexor tendon repair are based on combinations of various types of core sutures and circumferential epitenon sutures. Literature shows a tendency of replacing earlier 2-strand core tendon sutures with novel multistrand core sutures, however the results of meta-analyses do not confirm any definitive superiority over traditional techniques. Likewise, literature does not provide conclusive evidence that early active postoperative mobilization results in better outcomes than active-passive and controlled passive mobilization techniques. The choice of the method of flexor tendon repair and postoperative rehabilitation protocol depends only in part on scientific evidence, but more on individual or institutional preference of the surgeon.

Early Active Mobilisation Following Flexor Tendon Repair in Zone 2

1989 ◽  
Vol 14 (4) ◽  
pp. 383-391
Author(s):  
J. O. SMALL ◽  
M. D. BRENNEN ◽  
J. COLVILLE
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Grading System ◽  
Flexor Tendon Repair ◽  
Active Range Of Motion ◽  
Flexor Tendon Injuries ◽  
American Society ◽  
A Prospective Study ◽  
Similar Programme

In a prospective study, 114 patients with 138 zone 2 flexor tendon injuries were treated over a three-year period. Early active mobilisation of the injured fingers was commenced within 48 hours of surgery. 98 patients (86%) were reviewed at least six months after operation. Using the grading system recommended by the American Society for Surgery of the Hand, the active range of motion recovered was graded excellent or good in 77% of digits, fair in 14% and poor in 9%. Dehisence of the repair occurred in 11 digits (9.4%) and in these an immediate re-repair followed by a similar programme of early active mobilisation resulted in an excellent or good outcome in seven digits.

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