Functional outcome of flexor tendon repair of the hand at Zone 5 and post operative early mobilization of the fingers

Seyed Abdolhossein Mehdi Nasab,Nasser Sarrafan,Seyed Reza Saeidian,Hassan Emami

doi:10.12669/pjms.291.2563

Abstract

Objective : There are few reports on outcome following flexor tendon repair of the hand in zone 5. We hypothesized that early mobilization of the fingers is possible if the suture site of repaired tendon is strong enough. The aim of this study was to assess the results of flexor tendon repair in this zone using modified Kessler method reinforced by peripheral running suture and a post operative early active and passive mobilization of the fingers. Methodology: This prospective study was carried out between April 2006 and Feb 2010, and 171 digits flexor tendons cut in 42 patients were repaired by modified Kessler technique reinforced by running peripheral suture. Early active mobilization and gentle passive motion of the fingers was allowed in a dorsal wrist splint the day after surgery. Wrist Immobilization was performed for one month. Function of the tendons was assessed by Buck-Gramcko score at nine month follow up. Results: Mean age of the patients was 25.4 years (range 17-46 y). Twenty nine flexor policis longus, 77 flexor digitorum superficialis and 65 flexor digitorum profundus tendons of digits were repaired. Middle and index fingers were most commonly involved. Median and ulnar nerve repair was done in 17 and 12 cases respectively. Good to excellent results were seen in of 79.34% of FPL and 74.65% of other finger flexors. One case of FPL rupture was seen. Tenolysis of FDS was performed in one case. Recovery in thenar muscle function was good, fair and poor in 5, 2 and 10 cases after median nerve repair, while all 12 patients with ulnar nerve lesion showed some degrees of clawing of 4th and 5th fingers. Conclusion : Most patients following flexor tendon repair at zone 5 obtained good results. Early motion of the fingers seems to improve outcome in these patients. Concomitant nerve cut in particular of ulnar nerve were associated with a high rate of poor results.

Highlights

Hand is one of the most active parts of the body, and its normal function is essential for daily activities
On the other hand there is little in the literature to indicate the best protocol of post operative rehabilitation after flexor tendon repair in zone 5.5,6,7
Results of flexor tendon repair depends on many factors such as time since injury, technique of suture, associated injuries, surgeon’s experience, and post operative rehabilitation

Summary

INTRODUCTION

Hand is one of the most active parts of the body, and its normal function is essential for daily activities. Despite many surgical techniques and appropriate rehabilitation programs, flexor tendon injuries may be associated with adhesion formation and loss of hand function.[3,4] Primary surgical repair with restoration of length, strength and gliding excursion of tendon cut is essential and primary repair would have the best outcome. Results of flexor tendon cut after repair depends on many factors such as concomitant nerve injury, technique and type of repair, surgeon’s experience, nature of the lesion, and post operative rehabilitation. Though this injury is frequently seen at our emergency department, but no studies have been done to assess their functional outcome in our region. The aim of this study was to evaluate the results of flexor tendon laceration repair in zone 5 treated with early motion of the digits after surgery

METHODOLOGY

Evaluation

RESULTS

DISCUSSION