Zone II Flexor Pollicis Longus Repair: Thumb Flexion and Complications

Area of Science:

• Orthopedic surgery
• Hand surgery
• Traumatology

Background:

• Flexor pollicis longus (FPL) repair aims for construct strength during rehabilitation and optimal active range of motion.
• Zone II FPL lacerations present unique challenges for surgical repair and functional recovery.

Purpose of the Study:

• To identify factors influencing active thumb interphalangeal (IP) joint flexion post-FPL repair.
• To determine factors associated with reoperation following primary Zone II FPL laceration repair.

Main Methods:

• Retrospective review of 104 patients undergoing primary Zone II FPL repair between 2000 and 2016.
• Data collection included patient, injury, and surgical characteristics, postoperative active IP-flexion, and reoperation rates.
• Bivariate analyses were used to assess influencing factors for active IP-flexion and reoperation.

Main Results:

• The reoperation rate was 17%, with adhesions and re-rupture as primary indications.
• Median active IP-flexion was 30°. Solitary thumb injury and epitendinous suture use correlated with increased active IP-flexion.
• No factors were statistically linked to reoperation.

Conclusions:

• Approximately 17% of patients require reoperation for Zone II FPL lacerations, primarily within six months.
• Epitendinous suture use is associated with improved active IP-flexion.
• Concurrent injuries to multiple digits negatively impact IP-joint motion following FPL repair.