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Treatment of tendon injuries in children
Insights
Pediatric hand tendon injuries heal best with primary repair, offering superior outcomes compared to adults. Secondary tendon grafting also yields good results, even after failed primary repairs, ensuring functional recovery in children.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Pediatric Hand Surgery
Background:
- Tendon injuries in children's hands present unique challenges for diagnosis and treatment.
- While primary repair offers better outcomes, secondary grafting is a viable option for salvage or failed repairs.
Purpose of the Study:
- To review the principles and outcomes of pediatric hand flexor tendon injuries.
- To outline management strategies based on patient age and injury type.
Main Methods:
- Review of current literature on pediatric hand tendon repairs.
- Discussion of surgical techniques, including primary repair and tendon grafting.
- Emphasis on age-appropriate immobilization and postoperative care.
Main Results:
- Primary tendon repair in children yields superior results compared to adults at all levels.
- Secondary tendon grafting provides predictable, satisfactory outcomes and can salvage failed primary repairs.
- Age-specific immobilization (above-elbow for <6 years, dorsal splint with traction for >6 years) is crucial.
Conclusions:
- Meticulous surgical technique and magnification are essential for successful pediatric tendon repair due to small structures.
- Early and accurate diagnosis, including wound exploration when necessary, is vital.
- Procedures should be performed by hand surgeons experienced in pediatric tendon repair and grafting.
Abstract:
Tendon injuries in the child's hand can be repaired primarily with better results than in the adult; this is true at all levels, including the digital sheath. In less than ideal circumstances, secondary conventional tendon grafting also provides predictable satisfactory results and can also salvage a failed primary repair. In children under the age of six years with digital flexor tendon repairs, the limb must be immobilized above the elbow. In the cooperative child over the age of six years with a primary repair of a lacerated flexor tendon, the dorsal splint with rubber band traction as described by Kleinert is recommended. Preoperative diagnosis of tendon injuries in the young child is difficult. If there is any doubt after observing the child using his hand, the wound must be explored and tendons and nerves identified to ensure their integrity. Even though the results of tendon repair in children are better than in adults, the structures are small, technique must be meticulous, and magnification must be used. Specially trained hand surgeons experienced in primary tendon repair and tendon grafting should perform these procedures, for this elegant structure deserves the finest attention.