Surgery and Rehabilitation Following Flexor Tendon Zone II Injury of the Hand: A Literature Review (original) (raw)

Improving Results of Flexor Tendon Repair and Rehabilitation

Plastic and Reconstructive Surgery, 2014

he management of flexor tendon injuries remains one of the most published topics in hand surgery, with the numbers of publications on this subject seeing a year-onyear increase (Fig. 1). The perfect repair and outcome continue to evade us, 1 despite the flexor tendon repair being one of the earliest skills acquired as a hand surgeon in either plastic or orthopedic surgery training. 2 New tendon repairs and hand therapy regimens are reported regularly. Occasionally, there is an announcement of a new treatment modality that promises hope for this clinical conundrum, but this rarely becomes part of standard practice. Over the past 50 years, there have been many innovations, but overall outcomes have not changed dramatically. For example, the best series published in the 1970s showed that a two-strand repair with simple circumferential suture and a Kleinert type rehabilitation regimen had a 5 percent rupture rate, with 75 percent of patients achieving good to excellent functional outcomes in 28 zone II injuries. 3 This compares favorably with more recent studies showing that a four-strand repair and early active mobilization regimen had a 5 percent rupture rate, with 71 percent achieving good to excellent outcomes in 73 cases. 4 Real paradigm shifts in this area require us to rethink the whole process of flexor tendon biology Disclosure: Neither author has a financial interest in any of the products or devices mentioned in this article.

Postoperative Management of Flexor Tendon Repair in Zone 2

Journal of Physical Therapy Science, 2000

Rehabilitation of flexor tendons in zone 2 is very important in order to have satisfactory results after the surgical repair. This study reports the results of the rehabilitation program which was applied to 25 patients (36 digits) after zone 2 repair. A treatment approach that combines early controlled passive motion and early controlled mobilization was used. Patients were evaluated regarding the total active motion (TAM), grip strength, pinch strength, finger dexterity and the disability in daily living activities at the 24th week. TAM results were excellent in 4%, good in 68%, fair in 23% and poor in 5% of the repaired digits. Grip strength results were good in 69%. Pinch meter results were improved in 76%. Hand disability which existed in all patients before the rehabilitation program was found to appear mildly in 72% of the patients. Finger dexterity was rated normal for 64% of the group after the therapy. We conclude that zone 2 is a critical zone in flexor tendons and immediate postoperative mobilization should be allowed for minimal formation and adhesion.

Flexor tendon injuries

Journal of Clinical Orthopaedics and Trauma, 2019

Flexor tendon injuries have constituted a large portion of the literature in hand surgery over many years. Yet many controversies remain and the techniques of surgery and therapy are still evolving. The anatomical and finer technical considerations involved in treating these injuries have been put forth and discussed in detail including the rehabilitation following the flexor tendon repair. The authors consider, recognition and mastery of these facts form the foundation for a successful flexor tendon repair. The trend is now towards multiple strand core sutures followed by early active mobilization. However, the rehabilitation process appears to be one of the major determinant of the success following a flexor tendon repair. Early mobilization is essential for all the flexor tendon repairs as it is proved to improve the quality of the repaired tendon. The art of achieving the harmony between a stronger repair and unhindered gliding of the repair site through the narrow flexor tendon sheath simultaneously can be mastered with practice added to the knowledge of the basic principles. © 2019 2.2. Pulley system There is a fibrous flexor sheath surrounding the tendon extending from the neck of the metacarpal to the base of the distal phalanx. At certain places, the sheath is thickened, called the pulleys.

An overview of the management of flexor tendon injuries

The open orthopaedics journal, 2012

Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. Since the first flexor tendon repair was described by Kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 70-90%. Primary surgical repair results in better functional outcome compared to secondary repair or tendon graft surgery. Flexor tendon injury repair has been extensively researched and the literature demonstrates successful repair requires minimal gapping at the repair site or interference with tendon vascularity, secure suture knots, smooth junction of tendon end and having sufficient strength for healing. However, the exact surgical approach to achieve success being currently used among surgeons is still controversial. Therefore, this review aims to discuss the results of studies demonstrating the current knowledge regarding the optimal approach for flexor tendon repair. Post-operative rehabilitation for flexor te...

Treatment of flexor tendon injuries: Surgeons' perspective

Journal of Hand Therapy, 1999

R estor ation of digital function following flexor tendon injury continues to challenge the hand surgery and therapy communities. Stiffness and scarring leading to functional impairment continue to frustrate the most experienced surgeons, therapists, and compliant patients. Despite efforts to improve the results of flexor tendon repairs, restrictive adhesions affixing the injured tendon to the flexor tendon sheath continue to compromise functional recovery more than any other problem. Joint contracture and repair rupture present additional obstacles to a successful outcome following repair of flexor tendons. The irreparable tendon and tendon sheath requiring reconstruction remain a troublesome clinical presentation. This paper reviews flexor tendon literature defining today's understanding of the flexor tendon system's response to injury and surgical reconstruction. New techniques will continue to evolve, each having the goal of promoting tendon gliding and limiting postoperative adhesions. As the new millennium approaches, we edge closer to the goal of predictably restoring normal hand function after flexor tendon injury. This paper is followed, on p. 149, by a paper presenting a hand therapist's commentary on the same subject.

Rehabilitation outcomes in patients with early and two-stage reconstruction of flexor tendon injuries

Journal of Physical Therapy Science, 2016

Purpose] The primary aim of this study was to assess rehabilitation outcomes for early and two-stage repair of hand flexor tendon injuries. The secondary purpose of this study was to compare the findings between treatment groups. [Subjects and Methods] Twenty-three patients were included in this study. Early repair (n=14) and two-stage repair (n=9) groups were included in a rehabilitation program that used hand splints. This retrospective evaluated patients according to their demographic characteristics, including age, gender, injured hand, dominant hand, cause of injury, zone of injury, number of affected fingers, and accompanying injuries. Pain, range of motion, and grip strength were evaluated using a visual analog scale, goniometer, and dynamometer, respectively. [Results] Both groups showed significant improvements in pain and finger flexion after treatment compared with baseline measurements. However, no significant differences were observed between the two treatment groups. Similar results were obtained for grip strength and pinch grip, whereas gross grip was better in the early tendon repair group.

Functional outcome in patients with zone V flexor tendon injuries

Archives of Orthopaedic and Trauma Surgery, 2005

Introduction Zone V flexor tendon injuries may involve major nerves and arteries as well as the wrist and finger flexors. Although these injuries are not infrequent, few studies have reported functional outcomes. The purpose of this study was to evaluate the functional outcome in patients with flexor tendon repairs in zone V. Materials and methods Eighteen patients with repaired zone V flexor tendon injuries were followed up for an average of 20 months. The postoperative rehabilitation program consisted of a combined regime of modified Kleinert and modified Duran techniques. Outcome parameters were hand function according to the Buck-Gramcko assessment system, grip and key pinch strength values, and return to work status. Results Functional results were excellent in 92.8% of the digits, good in 1.4%, and poor in 5.8%. Grip strength recovered to an average of 77% and pinch strength to 74% of the uninjured hand. Two tendon ruptures occurred in a patient, and tenolysis was required in 3 patients. Of 15 patients who were employed at the time of injury, 13 returned to their original occupations. Conclusion Satisfactory functional results can be obtained when proper surgical technique is coupled with careful postoperative management in patients with zone V flexor tendon injuries.

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. Conclusions: The authors' technique anchors the flexor digitorum profundus tendon or the graft in an anatomical position on the distal phalanx, without the need for external sutures or additional incisions. Furthermore, this is accomplished with minimal morbidity to the surrounding highly specialized tissue. The authors' results compare favorably with those of other techniques in the literature.

The results of immediate re-repair of zone 1 and 2 primary flexor tendon repairs which rupture

The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 2006

This study reports the outcome of immediate re-repair of primary flexor tendon repairs in zones 1 and 2 of the fingers which had ruptured. Between June 1989 and May 2003, a total of 62 fingers in 61 patients presented with ruptured flexor tendon repairs within 48 hours from rupture. Immediate re-repair and rehabilitation was carried out in 44 fingers (71%) in 43 (70%) patients. Thirty-six patients completed the 8-week therapy programme after re-repair in 37 fingers. Nine (24%) had excellent, 10 (27%) good, 5 (14%) fair and 13 (35%) had poor results when assessed by the original Strickland method. Five fingers in five patients ruptured the re-repair. Poor results and second ruptures were particularly common after re-repair of ruptured tendon repairs in the little finger. In the light of these findings, a policy for dealing with ruptured primary flexor tendon repairs in the fingers is suggested.