Flexor tendon injuries in children

Area of Science:

• Pediatric Orthopedics
• Hand Surgery
• Reconstructive Surgery

Background:

• Flexor tendon injuries in children present unique challenges compared to adults.
• Early and effective surgical intervention is crucial for restoring hand function.
• Pediatric patients exhibit distinct healing characteristics influencing surgical outcomes.

Purpose of the Study:

• To evaluate the efficacy of primary suture and controlled mobilization for pediatric flexor tendon injuries.
• To compare outcomes of repairing both flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) tendons versus FDP alone.
• To assess the long-term functional recovery and complication rates in children undergoing flexor tendon repair.

Main Methods:

• Retrospective review of 38 children (mean age 6.7 years) treated between 1985-1992.
• Surgical repair via primary suture followed by controlled mobilization.
• Classification of outcomes using Lister's criteria.
• Analysis of injury zones, specifically zone 2, and associated nerve injuries.

Main Results:

• 82% of patients achieved excellent or good results based on Lister's criteria.
• Injuries most commonly affected the little finger (23 patients) and occurred in zone 2 (60%).
• Repair of both FDS and FDP tendons yielded superior outcomes compared to FDP repair alone, even in zone 2.

Conclusions:

• Primary suture and controlled mobilization provide excellent outcomes for pediatric flexor tendon injuries.
• Repairing both FDS and FDP tendons is recommended for optimal functional recovery in children.
• Children demonstrate superior healing and pliability, leading to better results and fewer complications like adhesions requiring tenolysis compared to adults.