Conservative management of zone II partial flexor tendon lacerations greater than half the width of the tendon

Over a 5-year-period 15 patients with zone II partial flexor tendon lacerations that were larger than half the width of the tendon were treated conservatively without tendon suturing. Surgical exploration was done with a digital block and the flexor tendons were observed as the patient fully extended and flexed the finger. If present, the cause of triggering was determined and eliminated by trimming any beveled tendon edge, resection of the involved pulleys, and repair of the flexor sheath. Early protected mobilization was started the first day after injury using a dorsal splint. At 4 weeks after injury the splint was removed and exercises against resistance were started. None of the patients had triggering or rupture of the flexor tendons. Using the Strickland-Glogovac evaluation method, results were excellent in 93% of cases and good in the remaining 7%. It was concluded that conservative management of zone II partial flexor tendon lacerations larger than half the width of the tendon is safe as long as certain guidelines regarding the prevention of triggering and protected mobilization are applied.