Zone 2 flexor tendon repair in young children: a comparative study of four-strand versus two-strand repair

Area of Science:

• Orthopedic Surgery
• Pediatric Hand Surgery
• Reconstructive Surgery

Background:

• Zone 2 flexor tendon lacerations in children present unique challenges for surgical repair.
• The choice of repair technique impacts functional outcomes and re-rupture rates.
• Pediatric patients require specialized considerations due to their growth and activity levels.

Purpose of the Study:

• To compare the active range of motion and rupture rates of two-strand versus four-strand repairs for zone 2 flexor tendon injuries in young children.
• To evaluate the efficacy of modified Strickland techniques in pediatric flexor tendon repair.
• To determine if repair strength influences functional recovery in pediatric patients.

Main Methods:

• A prospective study involving 29 pediatric patients (under 4 years) with 32 zone 2 flexor tendon lacerations.
• Randomized repair of injured tendons using either two-strand or four-strand modified Strickland techniques.
• Assessment of total active motion of interphalangeal joints at a mean follow-up of 11 months.

Main Results:

• Mean total active motion was comparable between groups: 156 degrees (two-strand) and 158 degrees (four-strand), representing 89% and 90% of normal function, respectively.
• No ruptures occurred in the four-strand repair group.
• One two-strand repair failed due to rupture within 3 weeks post-operatively.

Conclusions:

• Both two-strand and four-strand flexor tendon repairs yield similar active finger motion ranges in young children.
• Four-strand repairs demonstrated a superior safety profile with zero ruptures compared to a single rupture in the two-strand group.
• While not statistically significant in this cohort, the trend suggests four-strand repairs may offer improved strength and reduced re-rupture risk in pediatric zone 2 flexor tendon injuries.