Flexor Tendon Injuries and Repairs: A Single Centre Experience

2018 ◽  
Vol 23 (04) ◽  
pp. 487-495 ◽  
Author(s):  
Min Kai Chang ◽  
Shian Chao Tay
Keyword(s):  
Flexor Tendon ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Dominant Hand ◽  
Single Digit ◽  
Economic Implications ◽  
Injury Characteristics ◽  
Patient Demographics ◽  
Flexor Tendon Injuries ◽  
Flexor Digitorum

Background: Although flexor tendon injuries cause significant morbidities and socio-economic implications, there have been limited data on patient demographics, injury characteristics and surgical details. The aim of this study is to describe our experience in flexor tendon injuries and repairs.Methods: We performed a retrospective study of all digital flexor tendon injuries that were repaired from January 2011 to December 2014. The collected data included patient demographics, injury characteristics and surgical details.Results: A total of 214 patients, 308 digits with 446 flexor tendon repairs were identified. We found that males, non-residents, and 20–29 age group were most prone to flexor tendon injuries. Cleaners, labourers and related occupations were the most vulnerable. The mechanism of injury was usually work-related and mostly caused by glass. Most injuries involve both flexor digitorum profundus and flexor digitorum superficialis tendons. Concomitant digital nerve and vessel injuries were common. Most patients suffered zone 2 laceration of a single digit of the non-dominant hand. Most patients underwent procedures that lasted 1 to 2 hours, including multiple flexor tendon repairs, microsurgical repairs and other interventions.Conclusions: This study is the largest study on patient demographics, injury characteristics and surgical details on flexor tendon injuries and repairs. It could be used to plan resources and policies for the management and prevention of flexor tendon injuries.

Outcomes After Flexor Tendon Injuries in the Pediatric Population: A 10-Year Retrospective Review

Hand ◽  
2020 ◽  
pp. 155894472092665
Author(s):  
Minh N. Q. Huynh ◽  
Ammara Ghumman ◽  
Amisha Agarwal ◽  
Claudia Malic
Keyword(s):  
Flexor Tendon ◽  
Pediatric Population ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Complication Rates ◽  
Active Motion ◽  
Rehabilitation Protocol ◽  
Injury Characteristics ◽  
Patient Demographics ◽  
Flexor Tendon Injuries

Background: Pediatric outcomes after flexor tendon repairs are variable, and evidence in the literature remains scarce. Methods: Repair of pediatric flexor tendon injuries was reviewed over a 10-year period (2005-2015). Data collection consisted of patient demographics, injury characteristics, anesthetic choice, repair technique, rehabilitation protocol, American Society for Surgery of the Hand Total Active Motion (TAM) scores, and complications. Results: There were 109 patients included in our study, with a total of 162 digits injured and 235 flexor tendon injuries. The mean age was 12 ± 4.6 years. The small finger (48 of 162; 30%) and the flexor digitorum profundus tendon (126 of 235) were the most commonly injured. The mechanism of injury was mainly from a knife (46 of 109; 42.2%) in zone II (82 of 159; 52%). Injuries were mostly repaired under general anesthetic (61 of 104; 56%). The Kessler technique was the predominant repair mechanism (111 of 225 repairs; 49%). Most patients (103 of 109; 95%) had excellent or good TAM scores with 5 postoperative ruptures reported. The most common complication was stiffness (17 of 121 complications; 14%), with most patients having no complications ( 74 of 109 patients; 68%). Patients were commonly immobilized (mean 8.4 ± 10.3 weeks) with a splint (93 of 109; 85%). There were 85 patients who followed a postoperative rehabilitation protocol for 12 ± 18 weeks. Patient demographics, time of repair, injury characteristics, anesthetic choice, and rehabilitation protocol were not significantly correlated with TAM scores or complication rates. Conclusions: Pediatric tendon injuries have good outcomes with no predictive factors identified. Surgical repairs performed under local anesthetic have similar outcomes without increased rates of complications, but remain underused in the pediatric population.

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 Biomechanical Study of Two Peripheral Suture Methods on Repaired Tendons

Open Medicine ◽  
2014 ◽  
Vol 10 (1) ◽  
Author(s):  
Shixin Wang ◽  
Zhenling Qiu
Keyword(s):  
Flexor Tendon ◽  
Statistical Significance ◽  
Maximum Load ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Surgical Approaches ◽  
Length Group ◽  
Flexor Tendon Injuries ◽  
Stitch Length ◽  
Flexor Digitorum

AbstractFlexor digitorum tendon injuries are challenging conditions to manage to ensure optimal patient outcomes. While several surgical approaches with high success rates have been developed, there remains no gold standard for suture technique for the repair of flexor tendon injuries. In this study, we compared two distinct peripheral suture methods on the strength of repaired tendons. Pig flexor digitorum profundus tendons were used in biomechanical studies and the biomechanical influence on tendon repair of continuous running peripheral suture (CRPS) and continuous locking peripheral suture (CLPS), were compared, using stitch length ranging from 1mm to 5mm. In CRPS, the 1mm stitch length group displayed the highest maximum load and breaking power, which was 1.57 fold higher than the 2mm stitch length group. Pairwise comparison revealed that the 1 and 2mm groups were statistically different from the 3, 4, and 5mm stitch length groups while comparison among the latter groups was not statistically significant. For CLPS, the 1mm group exhibited consistently the highest maximum load strength and breaking power, which was twice the strength displayed by the 2mm group. Pairwise comparisons between groups showed statistical significance. For future repairs of flexor tendon injuries, 1mm stitch length is highly recommended for simple peripheral suture.

scholarly journals Two-stage reconstruction for flexor tendon injuries in zone II using a silicone rod and pedicled sublimis tendon graft

2010 ◽  
Vol 43 (01) ◽  
pp. 014-020
Author(s):  
Mohammed Heshmat Abdul-Kader ◽  
Mahmound A. M. Amin
Keyword(s):  
Flexor Tendon ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Two Stage ◽  
Tendon Reconstruction ◽  
Flexor Tendon Injuries ◽  
Silicone Rod ◽  
Zone Ii ◽  
The Mean ◽  
Flexor Digitorum

ABSTRACTWe report the results of staged flexor tendon reconstruction in 12 patients (12 fingers) with neglected or failed primary repair of flexor tendon injuries in zone II. Injuries involved both flexor digitorum profundus (FDP) and flexor digitorum sublimis (FDS), with poor prognosis (Boyes grades II–IV). The procedure included placing a silicone rod and creating a loop between the FDP and FDS in the first stage and reflecting the latter as a pedicled graft through the pseudosheath created around the silicone rod in the second stage. At a mean follow-up of 18 months (range 12–30 months), results were assessed by clinical examination and questionnaire. The mean total active motion of these fingers was 188°. The mean power grip was 80.0% and pinch grip was 76% of the contralateral hand. The rate of excellent and good results was 75% according to the Buck-Gramcko scale. These results were better than the subjective scores given by the patients. Complications included postoperative hematoma in two, infection in one, silicone synovitis in one (after stage I) and three flexion contractures after stage II. This study confirmed the usefulness of two-stage flexor tendon reconstruction using the combined technique as a salvage procedure to restore flexor tendon function with a few complications.

Flexor Tendon Injuries: The Results of Primary Repair

1988 ◽  
Vol 13 (3) ◽  
pp. 269-272
Author(s):  
M. SINGER ◽  
S. MALOON
Keyword(s):  
Flexor Tendon ◽  
Primary Repair ◽  
Hand Surgery ◽  
Tendon Injury ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendon Injuries ◽  
No Man's Land ◽  
Flexor Pollicis Longus Tendon ◽  
Flexor Digitorum

This study is a critical analysis of results obtained following primary repair and post-operative controlled mobilisation of flexor tendon injuries which were treated by registrars with up to six months experience in hand surgery. 70 (55%) of 125 patients who underwent repair of a complete flexor digitorum profundus or flexor pollicis longus tendon injury during a 14-month period attended for review and these had a total of 140 injured digits. 93 (67%) were rated Lister’s standards as an “excellent” or “good” result. 39 (28%) occurred in “no man’s land” (Zone 2) and only 19 (49%) in this area were rated “excellent” or “good”. Isolated flexor digitorum superficialis tendon injuries have been excluded from this study, as have partial tendon injuries.

scholarly journals FREQUENCY, DISTRIBUTION AND TREATMENT OF ACUTE FLEXOR TENDON INJURIES IN ZONE V OF HAND

2019 ◽  
Vol 17 (1) ◽  
pp. 11-14
Author(s):  
Muhammad Shafiq
Keyword(s):  
Median Nerve ◽  
Frequency Distribution ◽  
Radial Artery ◽  
Flexor Tendon ◽  
Tendon Injuries ◽  
Dominant Hand ◽  
Mechanism Of Injury ◽  
Results Of Treatment ◽  
Wound Size ◽  
Flexor Tendon Injuries

Background: Flexor tendons injuries are common emergency procedures The objectives of this study were to determine the frequency, distribution and results of treatment of acute flexor tendon injuries in zone V of hand in our population. Material and Methods: This descriptive cross-sectional was conducted in the Department of Orthopedic, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2017. Sample size was 30, selected through consecutive technique. Patients having flexor tendon injuries in zone v, admitted through emergency department were included in this study. Demographic variable were sex and age-groups. The research variable were tendon involved, nerves involved, artery involved, mechanism of injury, wound size, duration of injury, season, type of injury, hand involved and results of treatment. All variables, being categorical were analyzed by frequency and percentages using SPSS version 16.0. Results: Out of 30 patients, 22(73.33%) were male. Twenty four (80%) patients were between 21 to 40 years age. Mechanism of injury was glass in 16(53.33%) cases, knife in 10(33.33%) cases. Twenty (66.66%) cases presented in summer. Flexor digitorum sublimus was injured in 21(70.0%), FCR in 11(36.66%), FPL in 8(26.66), FDP in 6(20.0%) and FCU in 4(13.33%) cases. Median nerve was involved in nine (30%) cases. Radial artery was involved in eight (26.66%) cases. Wound size was 2 cm in 24(80%) cases. Sixteen (53.33 %) cases came with self-inflicted injuries. Twenty (66.66 %) cases came after 12 hours. Twenty five (83.33%) patients achieved good to excellent results. Conclusion: Flexor digitorus sublimus was the most common tendon injured in non-dominant hand, especially in young males. Median nerve and radial artery were commonly injured structures mostly with glass. Majority patients presented more than 12 hours after injury, having wound size of 2cm. Mostly the injuries were self-inflicted and occurred in summer season.

Repair Technique Using a Combination of Suture Anchor and Miniscrew in Flexor Digitorum Profundus Bony Avulsion Fracture with Bone Fragment in Zone 1

2018 ◽  
Vol 23 (03) ◽  
pp. 430-436
Author(s):  
Jae-Hwi Nho ◽  
Sang-Woo Lee ◽  
Mi-Ae Nam ◽  
Byung-Sung Kim ◽  
Ki Jin Jung
Keyword(s):  
Suture Anchor ◽  
Avulsion Fracture ◽  
Flexor Tendon ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Rare Injury ◽  
Pull Out ◽  
Bony Avulsion ◽  
Flexor Tendon Injuries ◽  
Pull Out Suture

Avulsion fracture of the volar base of the distal phalanx is a rare injury. Zone 1 flexor tendon injuries can be treated with either internal or external fixation techniques. Pull-out suture repairs are often used for FDP tendon avulsion injuries. However, the pull out suture technique is associated with a number of well documented complications including nail bed injury and pressure necrosis. Despite the variety of techniques available for the repair of acute distal zone 1 flexor tendon injuries, no one technique has proven to be superior to all others. We address our experience with treatment of FDP avulsion injuries using suture anchor and miniscrew. Our technique supplements the suture anchor technique, which often causes a lack of strength, with an additional miniscrew. We introduce two cases of combined method using both suture anchor and miniscrew for treatment of FDP avulsion injuries.

scholarly journals Outcomes of 200 digital flexor tendon repairs using updated protocols and 30 repairs using an old protocol: experience over 7 years

2019 ◽  
Vol 45 (1) ◽  
pp. 56-63 ◽  
Author(s):  
Zhang Jun Pan ◽  
Lei Pan ◽  
Yun Fei Xu ◽  
Tao Ma ◽  
Lei Hui Yao
Keyword(s):  
Flexor Tendon ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Flexor Pollicis Longus ◽  
Active Motion ◽  
Passive Motion ◽  
Motion Exercise ◽  
End To End ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

We reviewed outcomes of 230 flexor tendon repairs in 27 thumbs and 203 fingers in Zone 1 and 2 over 7 years. In 2013, we used a 2-strand modified Kessler method followed by passive motion exercise in repairing flexor digitorum profundus tendon injuries in Zone 2 in 30 fingers; 24 fingers were followed, five (26%) had repair ruptures. Between 2014 and 2017, we used a 4- or 6-strand method to repair 111 flexor digitorum profundus tendons in Zone 2, followed by true early active motion. Two had repair ruptures. Among 101 fingers followed over 6 months, two fingers had tenolysis and 87 (87%) good or excellent outcomes. In 2018 to 2019, we used a 6-strand method to repair 42 flexor digitorum profundus tendons in Zone 2 with out-of-splint early active motion. None had repair ruptures or tenolysis. From 2014 to 2019, 27 flexor pollicis longus tendons were repaired in Zone 1 or 2, and 20 fingers had end-to-end flexor digitorum profundus repairs in Zone 1; none had repair ruptures or tenolysis. We conclude that a strong repair and true active motion are necessary for best outcomes of flexor tendon repairs in the thumb and fingers, and out-of-splint true active motion is safe.

THE BUTTON-OVER-NAIL TECHNIQUE FOR ZONE I FLEXOR TENDON INJURIES

Hand Surgery ◽  
2012 ◽  
Vol 17 (03) ◽  
pp. 365-369 ◽  
Author(s):  
A. S. C. Bidwai ◽  
L. Feldberg
Keyword(s):  
Functional Outcome ◽  
Flexor Tendon ◽  
Surgical Complication ◽  
Tendon Injury ◽  
Outcome Data ◽  
Flexor Digitorum Profundus ◽  
Retrospective Case ◽  
Flexor Tendon Injury ◽  
Flexor Tendon Injuries ◽  
Flexor Digitorum

The "button over the nail" is the most commonly used technique in order to re-insert the flexor digitorum profundus tendon into the distal phalanx in the management of Zone 1 injuries. Recent evidence in the literature has highlighted an associated morbidity with the technique. In this study, 37 patients were identified that had been treated using the "button technique", for which outcome data is collected by hand therapists as part of a prospective flexor tendon injury audit. Retrospective case note review was performed to determine incidence of post-operative surgical complications. There were limited complications with the use of the "button technique" overall. However, functional outcome when compared to other studies are relatively poor with mean range of motion at the distal interphalangeal joint being 37.5 degrees. The authors would recommend any decision to change technique for the management of these injuries should consider functional outcome in the presence of a low surgical complication rate.

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