Related Experiment Videos
Flexor tendon injuries in children: factors influencing prognosis
F Fitoussi1, Y Lebellec, J M Frajman
1Robert Debré Hospital, Paris, France.
Insights
Pediatric flexor tendon injuries treated with the modified Kessler technique show excellent outcomes in 84% of cases. Younger children and zone II injuries influenced results, with 9% experiencing rupture.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Reconstructive Surgery
Background:
- Flexor tendon injuries in children are challenging due to unique anatomical and physiological factors.
- The Kessler modified technique is a common surgical approach for digital flexor tendon repair.
Purpose of the Study:
- To evaluate the outcomes of pediatric flexor tendon injuries treated with the Kessler modified technique.
- To identify factors influencing the results of surgical repair in children.
Main Methods:
- A retrospective review of 44 children with 58 injured fingers treated with the Kessler modified technique.
- Assessment of total active motion (TAM) using the Strickland formula at a mean 3-year follow-up.
- Analysis of factors including age, injury zone, tendon involvement, and immobilization type.
Main Results:
- Excellent or good outcomes were achieved in 89% of cases (84% excellent, 5% good).
- Factors associated with poorer outcomes included younger age (<5 years), zone II injuries, and both tendons injured within the digital canal.
- Rupture occurred in 9% of cases, predominantly in younger children with short postoperative immobilization.
Conclusions:
- The Kessler modified technique yields high success rates for pediatric flexor tendon injuries.
- Careful consideration of patient age, injury location, and immobilization is crucial for optimizing surgical outcomes.
- Early mobilization and nerve injury status did not significantly impact final results in this cohort.
Abstract:
We reviewed a series of 44 children with 58 fingers involved, 21 of them occurring in the digital canal. The core stitch was performed according to the Kessler modified technique. The mean follow-up at the time of review was 3 years. The return of total active motion (TAM) in the interphalangeal joints was evaluated with the Strickland formula. Results were excellent in 84%, good in 5%, fair in 2%, and poor in 9%. Influencing factors were children younger than 5 years, lesions in zone II, both tendon injuries in the digital canal, and the type of immobilization (below-elbow splint). Rupture occurred in 9%, especially in the very young children with a short postoperative immobilization. Variables such as the early-mobilization program, the length of the postoperative immobilization period, or concurrent digital nerve injury had no significant effect on the final result.