scholarly journals The influence of duration of Kleinert immobilization on the functional recovery of primarily reconstructed flexor tendons in children and adult patients

2006 ◽  
Vol 53 (3) ◽  
pp. 73-78 ◽  
Author(s):  
J. Jeremic ◽  
C. Vucetic ◽  
Z. Golubovic ◽  
I. Petronic ◽  
K. Jeremic
Keyword(s):  
Functional Recovery ◽  
Functional Disability ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Adult Patients ◽  
Postoperative Adhesions ◽  
Flexor Tendon Repair ◽  
Optimal Balance ◽  
Normal Tendon ◽  
Tendon Ruptures

Flexor tendon repair in the hand is very often complicated by the formation of peritendinous adhesions that result in loss of normal tendon gliding, digital stiffness and functional disability. While stability is critical for a successful tendon repair, mobility is also important, as motion of the repaired tendon decreases the formation of postoperative adhesions and increases the strength of the repair. Immobilization and its duration, can ensure the integrity of the repair but can also lead to scaring, stiffness, and joint contractures. This study included 20 children and 39 adult patients, in the period from January 2000 to April 2003., with flexor tendon ruptures of the hand. Tendons were primary repaired using direct tennoraphy, and postoperately patients were treated with Kleinert dynamic immobilization. The aim of this study was to investigate the influence of the duration of the dynamic immobilization on successful postoperative functional recovery, separately in children and adult patients. Research in this area has been directed at achieving the optimal balance between stability and mobility, without compromising one for the other. .

Flexor tendon repair: recent changes and current methods

2021 ◽  
pp. 175319342110537
Author(s):  
Jin Bo Tang ◽  
Donald Lalonde ◽  
Leila Harhaus ◽  
Ahmed Fathy Sadek ◽  
Koji Moriya ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Hand Surgery ◽  
Past Experience ◽  
Current Status ◽  
Flexor Tendon Repair ◽  
Clinical Methods

The current clinical methods of flexor tendon repair are remarkably different from those used 20 years ago. This article starts with a review of the current methods, followed by presentation of past experience and current status of six eminent hand surgery units from four continents/regions. Many units are using, or are moving toward using, the recent strong (multi-strand) core suture method together with a simpler peripheral suture. Venting of the critical pulleys over less than 2 cm length is safe and favours functional recovery. These repair and recent motion protocols lead to remarkably more reliable repairs, with over 80% good or excellent outcomes achieved rather consistently after Zone 2 repair along with infrequent need of tenolysis. Despite slight variations in repair methods, they all consider general principles and should be followed. Outcomes of Zone 2 repairs are not dissimilar to those in other zones with very low to zero incidence of rupture.

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 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.

scholarly journals Biological analysis of flexor tendon repair-failure stump tissue: a potential recycling of tissue for tendon regeneration

2019 ◽  
Vol 8 (6) ◽  
pp. 232-245 ◽  
Author(s):  
C-C. Lu ◽  
T. Zhang ◽  
R. L. Reisdorf ◽  
P. C. Amadio ◽  
K-N. An ◽  
...  
Keyword(s):  
Gene Expression ◽  
Growth Factor ◽  
Flexor Tendon ◽  
Adipogenic Differentiation ◽  
Tendon Repair ◽  
Haematopoietic Stem Cell ◽  
Flexor Tendon Repair ◽  
Tendon Regeneration ◽  
Biological Analysis ◽  
Normal Tendon

Objectives Re-rupture is common after primary flexor tendon repair. Characterization of the biological changes in the ruptured tendon stumps would be helpful, not only to understand the biological responses to the failed tendon repair, but also to investigate if the tendon stumps could be used as a recycling biomaterial for tendon regeneration in the secondary grafting surgery. Methods A canine flexor tendon repair and failure model was used. Following six weeks of repair failure, the tendon stumps were analyzed and characterized as isolated tendon-derived stem cells (TDSCs). Results Failed-repair stump tissue showed cellular accumulation of crumpled and disoriented collagen fibres. Compared with normal tendon, stump tissue had significantly higher gene expression of collagens I and III, matrix metalloproteinases (MMPs), vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and insulin-like growth factor (IGF). The stump TDSCs presented both mesenchymal stem and haematopoietic cell markers with significantly increased expression of CD34, CD44, and CD90 markers. Stump TDSCs exhibited similar migration but a lower proliferation rate, as well as similar osteogenic differentiation but a lower chondrogenic/adipogenic differentiation capability, compared with normal TDSCs. Stump TDSCs also showed increasing levels of SRY-box 2 (Sox2), octamer-binding transcription factor 4 (Oct4), tenomodulin (TNMD), and scleraxis (Scx) protein and gene expression. Conclusion We found that a failed repair stump had increased cellularity that preserved both mesenchymal and haematopoietic stem cell characteristics, with higher collagen synthesis, MMP, and growth factor gene expression. This study provides evidence that tendon stump tissue has regenerative potential. Cite this article: C-C. Lu, T. Zhang, R. L. Reisdorf, P. C. Amadio, K-N. An, S. L. Moran, A. Gingery, C. Zhao. Biological analysis of flexor tendon repair-failure stump tissue: A potential recycling of tissue for tendon regeneration. Bone Joint Res 2019;8:232–245. DOI: 10.1302/2046-3758.86.BJR-2018-0239.R1.

scholarly journals Ischaemic contracture of the hand

2006 ◽  
Vol 39 (01) ◽  
pp. 94-102
Author(s):  
G. Balakrishnan
Keyword(s):  
Suture Material ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Hypodermic Needle ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
Custom Made

ABSTRACTStronger flexor tendon repairs facilitate early active motion therapy protocols. Core sutures using looped suture material provide 1 ½ to twice the strength of Kessler′s technique (with four strand and six strand Tsuge technique respectively). The technique is well-described and uses preformed looped sutures (supramid). This is not available in many countries and we describe a technique whereby looped sutures can be introduced in flexor tendon repair by the use of 23 G hypodermic needle and conventional 4.0 or 5.0 sutures. This is an alternative when the custom made preformed sutures are not available. This can be practiced in zone 3 to zone 5 repairs. Technical difficulties limit its use in zone 2 repairs.

Methods of Evaluation of the Functional Results of Flexor Tendon Repair of the Fingers

1985 ◽  
Vol 10 (1) ◽  
pp. 60-61 ◽  
Author(s):  
A. B. NIELSEN ◽  
P. Ø. JENSEN
Keyword(s):  
Functional Outcome ◽  
Standard Method ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Functional Results ◽  
Functional Evaluation ◽  
Flexor Tendon Repair ◽  
Methods Of Evaluation ◽  
Method Of Measurement ◽  
No Man's Land

The methods used by Buck-Gramcko, Kleinert and Tsuge in evaluating the functional results of flexor tendon repair were each applied to assess the functional outcome in sixty-seven fingers where both tendons had been severed in “no man's land”. The method of Buck-Gramcko gave the highest rating, and the three methods showed evident differences in the results of evaluation after surgery. The study suggests a need for one standard method of measurement and recording, if a comparison of results after flexor tendon repair is to be of value. We found that the method of Buck-Gramcko incorporated the most essential features in the functional evaluation.

Looped suture properties: implications for multistranded flexor tendon repair

2015 ◽  
Vol 40 (3) ◽  
pp. 234-238 ◽  
Author(s):  
R. Haddad ◽  
T. Peltz ◽  
N. Bertollo ◽  
W. R. Walsh ◽  
S. Nicklin
Keyword(s):  
Mechanical Properties ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Relative Effect ◽  
Flexor Tendon Repair ◽  
Polypropylene Monofilament ◽  
Single Suture ◽  
Biomechanical Strength ◽  
Standard Techniques ◽  
Repair Techniques

Multiple-strand repair techniques are commonly used to repair cut flexor tendons to achieve initial biomechanical strength. Looped sutures achieve multiple strands with fewer passes and less technical complexity. Their biomechanical performance in comparison with an equivalent repair using a single-stranded suture is uncertain. This study examined the mechanical properties of double-stranded loops of 3-0 and 4-0 braided polyester (Ticron) and polypropylene monofilament (Prolene). Double loops were generally less than twice the strength of a single loop. Ticron and Prolene had the same strengths, but Ticron was stiffer. The 4-0 double loops had significantly higher stiffness than 3-0 single loops. Increasing the size of sutures had a larger relative effect on strength than using a double-stranded suture. However, a double-strand loop had a larger effect on increasing stiffness than using a single suture of a larger equivalent size. Looped suture repairs should be compared with standard techniques using a thicker single suture.

The effect of flexor tendon repair bulk on tendon gliding during simulated active motion: An in vitro comparison of two-strand and six-strand techniques

2001 ◽  
Vol 26 (5) ◽  
pp. 833-840 ◽  
Author(s):  
David W. Sanders ◽  
Andrew D. Milne ◽  
James A. Johnson ◽  
Cynthia E. Dunning ◽  
Robert S. Richards ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Active Motion ◽  
In Vitro Comparison
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