DOI: http://dx.doi.org/10.18203/2349-2902.isj20184632

Prognostic indicators affecting functional outcome in Zone II flexor tendon repairs

N. Kannan, S. Dhanaraju

Abstract


Background: Advances in surgical technique and rehabilitation have transformed zone II flexor tendon injuries from an inoperable no man's land to a standard surgical procedure. Despite these advances, many patients develop a substantial range of motion limiting adhesions after primary flexor tendon repair. To analyze the prognostic indicators, which influence the functional outcome in Zone II Flexor tendon injuries in fingers.

Methods: 21 patients with 28 Zone II Flexor Tendon Injuries who presented to us within 24 hours since the injury and repaired primarily were studied. Postoperatively hand is immobilized in a dorsal POP splint for 3 weeks. Pulsed ultrasound therapy was started on day 7, and continued upto 8 weeks.

Results: In the FFS Repaired group combined excellent and good results were obtained in 80% of patients. Zone II A good and excellent results were obtained in 81% of patients, whereas in II B in was 91%. In Zone II C60% of excellent and good results were obtained.

Conclusions: High-frequency musculoskeletal ultrasound is a better investigation in the postoperative follow up to find out tendon adhesions and rupture and most importantly dynamic assessment.


Keywords


Flexor tendon injuries, Injury to vincula, Proximal cut end of tendons, Ultrasound therapy

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References


Becker H, Orak F, Duponselle E. Early active motion following a beveled technique of flexor tendon repair: report on fifty cases. J Hand Surg Am. 1979;4:454-60.

Court JH, Uchiyama S, Amadio PC. Flexor tendon -pulley interaction after tendon repair. A biomechanical study. J Hand Surg Br. 1995:20:573-7.

Cooney WP, Weidman K, Malo D, wood MB. Management of acute flexor tendon injury in the hand. Instr Course Lect. 1985;34:373-81.

Diao E, Hariharan JS, Soejima O. Lotz JC. Effect of peripheral suture depth on strength of tendon repairs. J Hand Surg Am. 1996;21:234-9.

Evans RB, Thompson DE. Immediate active short arc motion following tendon repair. In: Hunter JM¸ Schneider LH, Mackin EJ, eds. Tendonand nerve surgery in the Hand: A Third Decade. St. Louis, Mosby; 1995;20:573-577.

Manske PR, Lesker PA. Flexor tendon nutrition. Hand Clinc Manual. 1985;1:13-24.

Mason ML, Allen HS. The rate of healing of tendons. An experimental study of tensile strength. Ann Surg. 1941;113:424-59.

Pruitt DL, Manske PR, Fink B. Cyclic stress analysis of flexor tendon repair. J Hand Surg Am. 1991;16:701-4.

Rispler D, Greenwald DF, Shumway S. Efficiency of the flexor tendon pulley system in human cadaver hands. J Hand Surg Am. 1996;21:444-50.

Seradge H. Elongation of the repair configuration following flexor tendon repair. J Hand Surg. 1983;8:182-5.

Silfverskiöld KL, May EJ. Flexor tendon repair with active moilizait on the Gothenburg experience. In Hunter JM, Schneider LH, Mackin EJ, eds. Tendon and nerve surgery in the hand; a third decade. St Louis, Mosby; 1997:342-532.

Silfverskiold KV, May EJ. Gap formation after flexor tendon repair in zone II. Results with a new controlled motion programme. Scand J Plast Reconstr Surg Hand Surg. 1993;27:263-8.

Trail IA, Powell ES, Noble J. An evaluation of suture materials use in tendon surgery. J Hand Surg Br. 1989;14:422-7.

Urbaniak J, Cahill J, Mortenson R. Tendon suturing methods analysis of tensile strength. AAOS Symposium on Tendon surgery in the Hand. St. Louis Mosby; 2004:124-127.

Wade PJ, Wetherell RG, Amis AA. Flexor tendon repair: significant gain in strength from the Halsted peripheral suture technique. J Hand Surg Br. 1989;14:232-5.