Current Treatments for Primary Injuries of the Flexor and Extensor Tendons

Abstract

Background: Treatment procedures for injuries of the flexor and extensor tendons have not been principally altered by the introduction of refined surgical techniques, new suture material, or the results of functional post-treatment. However, the treatment procedures have been more accurately defined and are now performed with greater precision. Methods: The concept of decompressing the suture, as described by Kleinert, is based on the principle of reciprocal innervation of agonists and antagonists. Pressure on the suture site is reduced by external dynamic spring splints. Results: Thus, the favourable results of functional post-treatment for injuries of the flexor tendon could be applied to extensor tendon injuries in zones IV–VIII as well. Three hundred and fifty patients have been treated by this suture technique and a dynamic splint, and were then followed. With the exception of three re-ruptures in the first ray, very good or good results were achieved. However, injuries in zones I–III are still mainly treated by static procedures. Three hundred and four flexor tendon injuries were treated with a primary flexor tendon suture. Seven per cent of our patients achieved a very good or good result, 3 % a satisfactory result. The re-rupture rate was less than 0.7 %, being below the rates reported in the published literature. Conclusions: A dynamic cast following surgery for recent extensor and flexor tendon injuries, in conjunction with an exact surgical technique, are essential for a smooth, early and good functional outcome of the treatment. The cast must provide complete decompression of the sutured tendon.