FLEXOR TENDON INJURIES OF HAND: EXPERIENCE AT PAKISTAN INSTITUTE OF MEDICAL SCIENCES, ISLAMABAD, PAKISTAN

Authors

  • Muhammad Ahmad
  • Syed Shahid Hussain
  • Farhan Tariq
  • Zulqarnain Rafiq
  • M. Ibrahim Khan
  • Saleem A. Malik

Abstract

Background: Flexor tendon injury is one of the most common hand injuries. This initial treatmentis of the utmost importance because it often determines the final outcome; inadequate primarytreatment is likely to give poor long tem results. Various suture techniques have been devised fortendon repair but the modified Kessler’s technique is the most commonly used. This study wasconducted in order to know the cause, mechanism and the effects of early controlled mobilizationafter flexor tendon repair and to assess the range of active motion after flexor tendon repair inhand. Methods : This study was conducted at the department of Plastic Surgery, Pakistan Instituteof Medical Sciences, Islamabad from 1st March 2002 to 31st August 2003. Only adult patients ofeither sex with an acute injury were included in whom primary or delayed primary tendon repairwas undertaken. In all the patients, modified Kessler’s technique was used for the repair usingnon-absorbable monofilament (Prolene 4-0). The wound was closed with interrupted nonabsorbable, polyfilament (Silk 4 -0) suture. A dorsal splint extending beyond the finger tip toproximal forearm was used with wrist in 20 – 30o palmer flexion, metacarpophalangeal (MP) jointflexed at 60o. Passive movements of fingers were started from the first post operative day, and forcontrolled, active movements, a dynamic splint was applied. Results: During this study, 33patients with 39 digits were studies. 94% of the patients had right dominated hand involvement.51% had the complete flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP)injuries. Middle and ring fingers were most commonly involved. Thumb was involved in 9% ofthe patients. Zone III (46%) was the commonest to be involved followed by zone II (28%).Laceration with sharp object was the most frequent cause of injury. Finger tip to distal palmercrease distance (TPD) was < 2.0 cm in 71% cases (average 2.4cm) at the end of 2nd postoperativeweek. Total number of patients was 34 at the end of 6th week. TPD was < 2.0 cm in 55% patientsand < 1.0 cm in 38% cases (average 1.5cm) at the end of 6th week. Total 9 patients were lost to thefollow up at the end of 8th week. TPD was < 1.0 cm in 67% (average 0.9cm) at the end of 8thpostoperative week. No case of disruption of repair was noted during the study. Conclusion: Earlyactive mobilization programme is essential after tendon repair. Majority of the patients (92%) hadfair to good results at the end of 2nd week which increased to 97% at the end of 8th week to good toexcellent.Keywords: Flexor Tendon Injury, Modified Kessler’s repair, Dynamic Splint

References

Lee WPA, Gan BG, Harris SU. Flexor tendons. In: Achauer

BM, Erickson E, Guyuron B, Colemen III JJ, Russell RC,

Vander Kolk CA eds. Plastic Surgery: Indications, Operations

and Outcomes. Philadelphia. Mosby Inc 2000;1961-82.

Leddy JP, Flexor tendons – acute injuries. In: green DP ed.

Operative hand surgery. 4th edition. London. Churchill

Livingstone1999; 711-71.

Page RF. Tendon injuries of the hand. Surgery 1997;15:227.

Ganatra MA. Prevention of hand deformities. Med Channel

; 3(1): 22-25.

Lee H. Double loop locking suture: a technique of tendon

repair for early active mobilization. J Hand Surg 1990;15(6):

-52(Part I), 953-58(Part II).

Keesler I. The grasping technique for tendon repair. Hand

; 5(3):253-55.

Meir AR, Koshy CE. Placement of sutures in tendon repair.

Br J Plast Surg 2000;53(2):172-373.

Boyce DE, Srivast ava S. Placement of sutures in tendon

repair. Br J Plast Surg 1999;52(6):511.

Peng YP, Lim BH, Chou SM. Towards a splint free tendon

repair flexor tendon injuries. Ann Acad Med Singapore 2002;

(5):593-97.

Nduka CC, Periera JA, Belcher HJCR. A simple technique to

avoid inadvertent damage to monofilament core suture

material during flexor tendon repair. Br J Plast Surg 2001;

:80-1.

Cetin A, Dincer F, Kecik A, Cetin M. Rehabilitation of flexor

tendon injuries by use a combined regimen of modified

Kleinert and modified Duran techniques. Am J Phys Med

Rehabil 2001;80(10:721-28.

Hung LK, Pang KW, Yeung PL, Cheung L, Wong JMW,

Chan P. Active mobilisation after flexor tendon repair:

comparison of results following injuries in zone 2 and other

zones. J Ortho Surg 2005;13(2):158-63.

Boyes JH. Flexor tendon grafts in the fingers and thumb: an

evaluation of end results. J Bone Joint Surg 1950;32: 489.

So YC, Chow S P, Pun WK, Luk KD, Crosby C, Nq C .

Evaluation of results in flexor tendon repairs: a clinical

analysis of five methods in ninety five digits. J Hand Surg

;15(2):258.

Athwal GS, Wolfe SW. Treatment of acute flexor tendon

injury: zones III-V. Hand Clin 2005; 21(2):181-6.

Neumeister M, Wilhemi BJ, Bueno RA Jr. Flexor tendon

lacerations. Available from URL.http://www.emedicine.com/

orthoped/topic94.htm accessed on 20-04 -2006.

Taras JS, Hunter JM. Acute tendon injuries. In: Cohen M ed.

Mastery of Plastic and Reconstructive Surgery. New York:

Little Brown and Co1994; 550-56.

Tang JB, Gu YT, Rice K, Chen F, Pan CZ. Evaluation of four

methods of flexor tendon repair for postoperative active

mobilization. Plast Reconstr Surg 2001;107(3):742-49.

Silfverskiold KL, May EJ. Flexor tendon repair in zone II

with a new suture technique and an early mobilization

programme combining passive and active flexion. J Hand

Surg 1994;19(1):53-60.

Tang JB, Shi D, Gu YQ, Chen JC, Zhou B. Double and

multiple looped suture tendon repair. J Hand Surg 1994;

(6): 699-703.

Strickland JW. The scientific basis for advances in flexor

tendon surgery. J Hand Ther 2005; 18(2):94-110.

Silfverskiold KL, May EJ, Tornvall A. Flexor digitorum

profundus excursion during controlled motion after flexor

tendon repair in zone II: a prospective clinical study. J Hand

Surg 1992;17:122-31.

Lilly SI, Messer TM. Complications after treatment of flexor

tendon injuries. J Am Acad Orthop Surg 2006;14(7):387-96.

Sirotakova M, Elliot D. Early active mobilization of primary

repairs of the flexor pollicis longus tendon with two Kessler

two strand core suture and a strengthened circumferential

suture. J Hand Surg 2004;29(6):531-35.

Ferguson RE, Rinker B . The use of a hydrogel sealant on

flexor tendon repairs to prevent adhesion formation. Ann

Plast Surg 2006; 56(1):54-8.

Savage R, Pritchard MG, Thomas M, Newcombe RG.

Differential splintage for flexor tendon rehabilitation: an

experimental study of its effect on finger flexion strength. J

Hand Surg 2005;30(2):168-74.

Downloads

Published

2007-03-01