Complications experienced in the rehabilitation of zone I flexor tendon injuries with dynamic traction splinting (original) (raw)
Related papers
Anatomical Repair of Zone 1 Flexor Tendon Injuries
Plastic and Reconstructive Surgery, 2009
Background: Repair and rehabilitation of the flexor digitorum profundus tendon in zone I may be demanding. The aim of the authors' study was to assess a new technique for reinsertion of the distal flexor digitorum profundus tendon. Methods: The authors' series consisted of 18 patients who required primary (n ϭ 10) or secondary (n ϭ 8) repair of the flexor digitorum profundus tendon in zone I. A half-Bruner incision was extended into the distal volar skin to expose the insertion site. Two drill holes were made through the base of the distal phalanx obliquely from the insertion of the profundus tendon in a dorsolateral direction. A modified Kessler suture was passed through the tendon and then through these holes and tied anteriorly, providing transosseous, internal fixation. Range of movement was assessed according to Moiemen's categories. Results: Fourteen patients had excellent or good results, two patients had fair results, and one patient had a poor result. One patient failed to complete physiotherapy and was lost to follow-up. No tendon rupture was documented during a mean follow-up period of 8 months.
Journal of Orthopaedic Research, 2004
Insertion site injuries of the flexor digitorum profundus (FDP) tendon often present for delayed treatment. Apart from gross observations made at the time of surgery, the changes that occur in the flexor tendon stump during the interval from injury to repair are unknown. These changes may include tendon softening and loss of viability, which may contribute to the poor outcomes observed clinically and experimentally. Thirty-eight FDP tendons from 23 adult dogs were transected sharply from their insertions on the distal phalanges and were not repaired. Dogs were allowed full weight bearing and were euthanized 7 or 21 days after injury. Biomechanical testing indicated that the resistance of injured tendons to pullout of a Kessler-type suture was not different from control tendons at I days and was increased at 21 days by 25% (p < 0.05). Morphologically, at 7 and 21 days the cut surface had a smooth appearance and the end of the injured tendon was increased in thickness by 30% and 50%, respectively (p < 0.05). Histologically, we observed increased cellularity and dramatic fibroblast proliferation within the injured tendon stump; there was no evidence of decreased cell viability. We conclude that during the interval from 0 to 21 days after FDP insertion-site injury, tendons cells are viable, proliferative and synthesizing new matrix. This leads to increased tendon size and enhanced resistance to suture pullout. These findings offer a scientific rationale supporting the clinical practice of surgical re-attachment within the first 3 weeks after injury.
Flexor tendon repair in children with zone 2 injuries: an innovative technique using autogenous vein
Journal of Pediatric Surgery, 2009
Objectives: This is a new technique for tendon repair that may improve the results of existing methods. Methods: The study is a nonrandomized retrospective study using historical (nonconcurrent) controls. From May 1994 to March 2004, 53 children aged 5 to 15 years requiring tendon repair (test group) were compared to 53 children conventionally repaired (control group). All patients had flexor tendon injuries, involving zone 2. In the test group (53 patients), a modified Kessler repairing of tendons with 4-0 prolene was used, followed by a core suture of running 7-0 nylon or prolene epitendinous suture. After the tendon repair, a segment of vein through which the tendon had been passed before or a vein patch used as a tendon sheath substitute was used to repair the sheath defects. The results during 6 months of follow-up were compared with those of the control group that were operated using the conventional technique (modified Kessler method). Results: We assessed the results by measuring the range of motion of the metacarpophalangeal, distal interphalangeal, and proximal interphalangeal joints in the follow-up period and graded them as excellent, good, fair, and poor. In the test group, 86% were graded as excellent, 11% good, 3% fair, and 0% poor results; and in the control group, 0% were excellent, 12% good, 38% fair, and 50% poor results. The differences were significant (P b .005). Conclusions: Our preliminary results appeared encouraging when compared with the outcomes achieved by the conventional tendon repair technique. As the new technique decreases the need for intensive physiotherapy, it may serve as a substitute method for the conventional tendon repair and eventually become a standard technique in the future.
Repairs of partial oblique tendon injuries: a biomechanical evaluation
Journal of Hand Surgery-british and European Volume, 2004
This study evaluated the tensile properties of oblique partial tendon lacerations and the effects of peripheral sutures on their strength. Seventy-four fresh pig flexor digitorum profundus tendons were divided into eight groups and were transected across 90% of their diameter. The lacerations in the tendons of five of the groups were at 01, 151, 301, 451, and 601 to their transverse cross-section, respectively. In the other three groups the lacerations were 01, 451, and 601 to the cross-section and were repaired with running peripheral sutures. The tendons were subjected to load-to-failure tests in a tensile testing machine to determine the initial, 1 and 2 mm gap formation forces, and the ultimate strength. Obliquity of tendon lacerations affected the strength of partially lacerated tendons. The tendons with 451 and 601oblique lacerations had a significantly lower ultimate strengths than those with transverse (01), or 151or 301 oblique lacerations. Running peripheral sutures significantly increased both the gap formation forces and the ultimate strength of the tendons with oblique partial lacerations.
Ifssh Flexor Tendon Committee Report
The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 2005
At its most basic, biomechanics is the study of the effects of bending, twisting, pulling, pushing and rubbing (shear) forces on living tissue. These effects provide, as limits, a mechanical description of biological tissue; as they relate to loading experienced in vivo, they describe the mechanical milieu in which living tissues operate. To the extent that the latter affect the former, one can speak of a "Wolff's Law of Soft Tissue", to describe the effect of function on form. Within the realm of hand surgery, no topic exceeds tendon injury and repair in the wealth of biomechanical data available, the thought that has gone into the analysis of that data, and the knowledge that has been gained as a result. This review will summarize the influence of biomechanical thought and research on the management of flexor tendon injury. Conceptually, the loads applied to tendons physiologically become the lower limit for the material properties of the tissue, if it is to function normally. Thus it is relevant to know the tensile strength of normal tendon, of various tendon repairs, and the loads that might be applied to healing tendons either during daily activity or with rehabilitation. Tendon repairs commonly fail by breaking at some point during the healing period. In vitro studies have shown that thicker core sutures, repairs with more strands crossing the laceration, and repairs with locking loops are stronger, and such repairs have been adopted clinically. A running peripheral suture does not increase the ultimate breaking strength much, but does increase the load needed to cause the repair to gap, especially when the running suture is locked. This may be useful as well, for several mechanical reasons discussed below, and on the basis of these mechanical studies, peripheral finishing sutures have been incorporated into tendon repairs, although the details of such sutures remain subject to discussion. Tendon repairs have also been studied in vivo, in animal models. It has been known since the 1940s, when Mason and Allen wrote their classic study, that repairs tend to weaken for the first few weeks, especially in immobilized tendons. More recently, it has become clear that this effect can be moderated considerably if tendons are moved postoperatively, and so early motion regimens have become incorporated into all tendon rehabilitation protocols. Whether loading of the tendon is also important remains controversial. Loading clearly stimulates isolated tendon cells and, in some cases, tendon tissue in vitro, but the results of loading programs in vivo, either in animal models or in clinical studies, have been unimpressive when compared to similar protocols which assure motion, but with minimal loading. Some unanticipated findings have been noted in the studies of partial tendon injuries, which again have influenced clinical practice. For partial lacerations that affect less than 90% of the tendon cross-section, a repair results in a weaker tendon postoperatively than no repair. Even