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Outcome of early active mobilization after flexor tendons repair in zones II-V in hand

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Author(s): Saini Narender | Kundnani Vishal | Patni Purnima | Gupta S

Journal: Indian Journal of Orthopaedics
ISSN 0019-5413

Volume: 44;
Issue: 3;
Start page: 314;
Date: 2010;
Original page

Keywords: Early mobilization | repair of flexor tendons | splints

ABSTRACT
Background: The functional outcome of a flexor tendon injury after repair depends on multiple factors. The postoperative management of tendon injuries has paved a sea through many mobilization protocols. The improved understanding of splinting techniques has promoted the understanding and implication of these mobilization protocols. We conducted a study to observe and record the results of early active mobilization of repaired flexor tendons in zones II-V. Materials and Methods: 25 cases with 75 digits involving 129 flexor tendons including 8 flexor pollicis longus (FPL) tendons in zones II-V of thumb were subjected to the early active mobilization protocol. Eighteen (72%) patients were below 30 years of age. Twenty-four cases (96%) sustained injury by sharp instrument either accidentally or by assault. Ring and little finger were involved in 50% instances. In all digits, either a primary repair (n=26) or a delayed primary repair (n=49) was done. The repair was done with the modified Kessler core suture technique with locking epitendinous sutures with a knot inside the repair site, using polypropylene 3-0/4-0 sutures. An end-to-end repair of the cut nerves was done under loupe magnification using a 6-0/8-0 polyamide suture. The rehabilitation program adopted was a modification of Kleinert′s regimen, and Silfverskiold regimen. The final assessment was done at 14 weeks post repair using the Louisville system of Lister et al. Results: Eighteen of excellent results were attributed to ring and little fingers where there was a flexion lag of < 1 cm and an extension lag of < 15o. FPL showed 75% (n=6) excellent flexion. 63% (n=47) digits showed excellent results whereas good results were seen in 19% (n=14) digits. Nine percent (n=7) digits showed fair and the same number showed poor results. The cases where the median (n=4) or ulnar nerve (n=6) or both (n=3) were involved led to some deformity (clawing/ape thumb) at 6 months postoperatively. The cases with digital or common digital nerve involvement (n=7 with 17 digits) showed five excellent, two good, four fair, and six poor results. Complications included tendon ruptures in 2 (3%) cases (one thumb and one ring finger) and contracture in 2 (3%) cases whereas superficial infection and flap necrosis was seen in 1 case each. Conclusion: The early active mobilization of cut flexor tendons in zones II-V using the modified mobilization protocol has given good results, with minimal complications.
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