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Results of zone I and zone II flexor tendon repairs in children
S J O'Connell1, M M Moore, J W Strickland
1Desert Orthopaedic Center, Eisenhower Medical Center, Rancho Mirage, CA 92270.
Insights
Pediatric flexor tendon repair in zones I and II shows excellent outcomes. Immobilization longer than four weeks negatively impacts function, while early motion yields comparable results across age groups.
Area of Science:
- Hand Surgery
- Pediatric Orthopedics
- Reconstructive Surgery
Background:
- Flexor tendon lacerations in children, particularly in zones I and II, require careful management.
- Optimal post-operative care, including immobilization duration and motion protocols, is crucial for functional recovery.
Purpose of the Study:
- To evaluate the functional outcomes of pediatric flexor tendon repairs in zones I and II.
- To determine the impact of patient age, immobilization period, and growth on digital function.
- To compare early passive motion versus prolonged immobilization strategies.
Main Methods:
- A combined study of 78 pediatric patients (<16 years) with 95 flexor tendon lacerations (zones I/II).
- Assessment of digital function with an average 24-month follow-up.
- Analysis of outcomes based on age groups (0-5, 6-10, 11-15 years), immobilization duration, and injury type.
Main Results:
- Zone I profundus repairs achieved excellent function.
- Zone II repairs (profundus/superficialis) showed comparable results with early passive motion or 3-4 weeks immobilization.
- Immobilization >4 weeks led to significant functional decline.
- Outcomes were similar across age groups for zone II injuries treated with <4 weeks immobilization or early motion.
- Associated nerve/palmar plate injuries resulted in less favorable outcomes.
Conclusions:
- Pediatric flexor tendon repair in zone I yields excellent results.
- For zone II injuries, immobilization <4 weeks or early motion is recommended, with no significant age-related differences.
- Prolonged immobilization (>4 weeks) should be avoided to prevent functional deficits.
- Growth may contribute to modest functional improvement over time.
Abstract:
In a combined study of three hand surgery practices, 78 patients younger than 16 years who had sustained flexor tendon lacerations in zone I or zone II of 95 digits were available for critical evaluation. The average postrepair follow-up period was 24 months (range, 3-144 months). Patient age was divided into three groups: 0-5 years, 6-10 years, and 11-15 years. Performance of all digits was assessed to determine the percentage return of normal digital function following repair. Data were analyzed to determine the effect of age, the effect of varying periods of postrepair immobilization, and the long-term changes in digital performance resulting from growth. All profundus repairs in zone I returned excellent function. Isolated profundus and combined profundus and superficialis repairs in zone II achieved comparable results when managed with an early passive motion program or following immobilization for 3 or 4 weeks. Immobilization for longer than 4 weeks resulted in an appreciable deterioration of function. Digital motion following zone II flexor digitorum profundus and superficialis injuries treated with less than 4 weeks of immobilization or early motion was not significantly different in the three age groups studied. Digits with associated digital nerve and/or palmar plate lacerations fared less favorably when compared with isolated tendon lacerations. In many digits, a modest improvement in digital motion was found when patients returned after several years of growth.