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Zone II flexor tendon repair in children. A retrospective long term study
1Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg University, Sweden.
Insights
Pediatric flexor digitorum profundus tendon repair outcomes show age is key. Early mobilization and timely repair did not significantly impact final results in children
Area of Science:
- Pediatric Hand Surgery
- Orthopedic Surgery
- Reconstructive Surgery
Background:
- Flexor digitorum profundus (FDP) tendon lacerations are common pediatric hand injuries.
- Optimal surgical repair and postoperative management strategies remain areas of investigation.
Purpose of the Study:
- To evaluate long-term functional outcomes following surgical repair of pediatric FDP tendon injuries.
- To identify factors influencing the return of total active motion (TAM) after FDP tendon repair in children.
Main Methods:
- Retrospective review of 43 children (46 digits) undergoing FDP tendon repair.
- Postoperative management included early controlled mobilization (Kleinert) or plaster immobilization.
- Functional outcomes assessed using the Strickland formula for total active motion (TAM).
Main Results:
- Mean TAM was 77% at a mean follow-up of 5.5 years.
- Child's age at injury was the only significant factor correlating with TAM.
- Postoperative regimen, repair timing, and injury characteristics did not significantly affect final TAM.
Conclusions:
- Age at injury is a critical determinant of long-term outcomes in pediatric FDP tendon repairs.
- Current postoperative protocols and repair timing strategies may not significantly alter functional recovery in this population.
Abstract:
Forty-three children with 46 lacerations of the flexor digitorum profundus tendon were evaluated at a mean of five and a half years (range three to 10) after tendon repair. Postoperatively, 27 digits were treated with early controlled mobilisation as described by Kleinert and 19 digits were immobilised in plaster. Thirty-one digits were primarily repaired within 24 hours, and in 15 digits repair was delayed. The return of total active motion (TAM) in the interphalangeal joints was evaluated with the Strickland formula, and the mean was 77%. TAM correlated with the age of the child at the time of injury. Variables such as postoperative regimen, concurrent injury to the superficial tendon or digital nerve, delayed tendon repair, localisation of injury in the fibro-osseous canal, and type of trauma, had no significant effect on the final result.