Two-stage flexor tendon reconstruction in zone II using Hunter's technique

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Reconstructive Surgery

Background:

• Zone II flexor tendon injuries are notoriously difficult to treat, with suboptimal outcomes, especially in delayed cases.
• Existing techniques for digital flexor tendon repair in zone II often yield unsatisfactory results.
• Hunter rod reconstruction offers a potential solution for complex and delayed zone II flexor tendon injuries.

Purpose of the Study:

• To evaluate the efficacy of a two-stage flexor tendon reconstruction using Hunter rods for delayed zone II injuries.
• To assess the functional outcomes of delayed zone II flexor tendon repair with Hunter rod technique.
• To determine the success rate of Hunter rod implantation in restoring digital function after old zone II flexor tendon injuries.

Main Methods:

• Retrospective study of 61 patients (106 fingers) undergoing two-stage Hunter rod reconstruction between 1974 and 1998.
• First stage: flexor tendon resection, Hunter rod implantation, and simultaneous repair of digital nerve injuries and pulleys.
• Second stage: tendon grafting (palmaris longus or plantaris) into the pseudosheath, with specific fixation methods (Pulvertaft and Bunnell's pullout wire).

Main Results:

• Good to excellent total active motion was achieved in 84% of the evaluated fingers.
• Fair results were observed in 12% of patients, and poor results in 4%.
• The technique demonstrated effectiveness in restoring digital function in cases of delayed zone II flexor tendon injuries.

Conclusions:

• Flexor tendon reconstruction using the Hunter technique is an effective method for delayed zone II injuries.
• The two-stage Hunter rod procedure provides a viable option for improving digital function in challenging hand trauma.
• This study supports the Hunter technique as a valuable reconstructive strategy for old zone II flexor tendon injuries.