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 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.

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.

PRIMARY REPAIR OF ZONE I FLEXOR TENDON INJURIES

Hand Surgery ◽  
2013 ◽  
Vol 18 (01) ◽  
pp. 79-83 ◽  
Author(s):  
A. S. C Bidwai ◽  
L. Feldberg
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Active Movement ◽  
Suture Repair ◽  
Excellent Outcome ◽  
Pinch Grip ◽  
Post Surgery ◽  
Flexor Tendon Injuries

Eighty-two patients who were treated by suture repair for Zone I flexor tendon injuries over a ten-year period were identified, to determine the incidence of post-operative surgical complications and subsequent re-operations. Eighty-five percent of patients completed 12 weeks follow-up post-surgery. Of these patients almost all had good to excellent outcome in terms of total active movement (TAM). However when assessing the range of motion at the distal interphalangeal joint (DIPJ), only 23% could be classified as having good or excellent results at final follow-up. A total of six patients (7.32%) required surgery for tendon repair complications. This study illustrates that DIPJ ROM is more indicative of functional recovery after tendon repair in flexor Zone I. Given the DIPJ is important in providing a fine pinch and a span pinch grip movements, patients should be counselled for inability to perform these functions post-tendon repair.

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.

The growth factors involved in flexor tendon repair and adhesion formation

2013 ◽  
Vol 39 (1) ◽  
pp. 60-70 ◽  
Author(s):  
O. A. Branford ◽  
B. R. Klass ◽  
A. O. Grobbelaar ◽  
K. J. Rolfe
Keyword(s):  
Growth Factors ◽  
Tendon Rupture ◽  
Flexor Tendon ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Clinical Problem ◽  
Flexor Tendon Repair ◽  
Flexor Tendon Injuries ◽  
Targeted Approach ◽  
Main Growth

Flexor tendon injuries remain a significant clinical problem, owing to the formation of adhesions or tendon rupture. A number of strategies have been tried to improve outcomes, but as yet none are routinely used in clinical practice. Understanding the role that growth factors play in tendon repair should enable a more targeted approach to be developed to improve the results of flexor tendon repair. This review describes the main growth factors in tendon wound healing, and the role they play in both repair and adhesion formation.

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.

scholarly journals Epidemiology of Flexor Tendon Injuries of the Hand in a Northern Finnish Population

2016 ◽  
Vol 106 (3) ◽  
pp. 278-282 ◽  
Author(s):  
M. Manninen ◽  
T. Karjalainen ◽  
J. Määttä ◽  
T. Flinkkilä
Keyword(s):  
Nerve Injury ◽  
Flexor Tendon ◽  
Adult Population ◽  
Tendon Injury ◽  
Tendon Injuries ◽  
Digital Nerve ◽  
Finnish Population ◽  
Rare Injury ◽  
Flexor Tendon Injury ◽  
Flexor Tendon Injuries

Background: Flexor tendon injuries cause significant morbidity in working-age population. The epidemiology of these injuries in adult population is not well known. The aim of this study was to describe the epidemiology of flexor tendon injuries in a Northern Finnish population. Material and Methods: Data on flexor tendon injuries, from 2004 to 2010, were retrieved from patient records from four hospitals, which offer surgical repair of the flexor tendon injuries in a well-defined area in Northern Finland. The incidence of flexor tendon injury as well as the gender-specific incidence rates was calculated. Mechanism of injury, concomitant nerve injuries, and re-operations were also recorded. Results: The incidence rate of flexor tendon injury was 7.0/100,000 person-years. The incidence was higher in men and inversely related to age. The most common finger to be affected was the fifth digit. In 37% of injuries also digital nerve was affected. The most common finger to have simultaneous digital nerve injury was the thumb. Conclusion: Flexor tendon laceration is a relatively rare injury. It predominantly affects working-aged young males and frequently includes a nerve injury, which requires microsurgical skills from the surgeon performing the repair. This study describes epidemiology of flexor tendon injuries and therefore helps planning the surgical and rehabilitation services needed to address this entity.

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.

Flexor Tendon Injuries

2018 ◽  
Author(s):  
Chao Long ◽  
Lisa C Moody ◽  
Paige M Fox ◽  
James Chang
Keyword(s):  
Flexor Tendon ◽  
Hand Function ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Surgical Techniques ◽  
Hand Surgery ◽  
Tendon Injuries ◽  
Pulley System ◽  
Rehabilitation Protocols ◽  
Flexor Tendon Injuries

Flexor tendon injuries are common hand injuries that can significantly affect hand function. Treatment of these injuries requires a thorough understanding of the intricate anatomy and biomechanics of flexor tendons. The goals of reconstruction include restoration of tendon continuity, preservation and reconstruction of the pulley system, maximizing tendon gliding, and minimizing adhesion formation. Surgical treatment, in conjunction with postoperative hand therapy, provides enhanced function. This review provides the surgeon with the relevant anatomy, pearls of clinical evaluation, necessary investigative studies, management algorithms, surgical techniques, rehabilitation protocols, and approaches to common complications. It ends with a discussion of basic and translational research currently being undertaken to address the challenges posed by flexor tendon injuries and how this research can potentially advance patient care.   This review contains 16 figures, 5 tables and 55 references Key words: flexor tendon, flexor tendon injuries, flexor tendon reconstruction, flexor tendon repair, hand, hand surgery, injury, surgical technique, tendons

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