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Flexor tendon repairs in children: Outcomes from a specialist tertiary centre
1Plastic Surgery Department, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
Insights
Early active mobilization (EAM) is a safe and effective rehabilitation method for pediatric flexor tendon repair. This approach yields good to excellent functional outcomes in most children, with low complication rates.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Rehabilitation Medicine
Background:
- Flexor tendon injuries in children require specialized rehabilitation.
- Early active mobilization (EAM) protocols aim to improve outcomes after surgical repair.
Purpose of the Study:
- To evaluate the functional outcomes of EAM following pediatric flexor tendon repair.
- To assess the safety and efficacy of EAM in a pediatric population.
Main Methods:
- Retrospective review of pediatric patients (2006-2013) undergoing flexor tendon repair.
- Implementation of a standardized EAM protocol with age-specific splinting.
- Assessment of outcomes using Total Active Mobilization (TAM) and original Strickland criteria (OSC).
Main Results:
- Good/excellent results achieved in 82% (TAM) and 79% (OSC) of analyzed cases.
- Most common repair zones were zone 2 (35%) and zone 1 (23%).
- Low complication rate including one rupture and three contractures.
Conclusions:
- EAM is a practical and safe rehabilitation strategy for pediatric flexor tendon repairs.
- The protocol effectively restores function without significantly increasing complications like ruptures or adhesions.
- Age-specific immobilization, including bulky bandages for younger children, is effective.
Abstract:
We evaluate the functional outcomes of early active mobilization (EAM) after paediatric flexor tendon repair at one centre from 2006 to 2013. A generic rehabilitation protocol was used for the first four to six weeks: boxing glove immobilization (<5 years), dorsal blocking splint and cage (5-10 years) or dorsal blocking splint ± cage (10-16 years). Outcomes were assessed using the Total Active Mobilization (TAM) method of the American Society for Surgery of the Hand and original Strickland criteria (OSC). Sixty-three fingers and 99 tendons were identified, in 57 children. Thirty-five per cent (n = 20) were in zone 2, 23% in zone 1, 18% in zone 5, 14% in zone 3 and 2% in zone 4. Good/excellent results were obtained in 82% by the TAM method and 79% by the OSC of those suitable for analysis (56 tendons in 44 children). The surgical approaches used varied in technique and material; a modified Kessler stitch (n = 42) using prolene (n = 60) represented the majority of core sutures. Epitendinous repair was employed in 76% of repairs (n = 75). The median length of hand therapy follow-up was 83.5 days (IQR 43.5-143.75 days). Complications included: one rupture, one post-operative infection requiring washout and three contractures, two requiring re-operation. EAM is a practical and safe way to rehabilitate children after flexor tendon repair, without increasing ruptures or adhesions. Most children under five are managed effectively in a bulky bandage.
