Injuries to Flexor Tendons of the Hand in Children

Abstract

This presentation relates our experience with sixty children who sustained tendon injuries or combined tendon and nerve injuries of the flexor surface of the hand. Sixty-four operative procedures were performed in this series of cases. Primary repair of divided flexor structures was undertaken in five patients, and in fifty-six patients secondary reconstructive procedures were performed. The majority of the patients were less than six years of age. Operative techniques in children were the same followed for older patients. The preoperative diagnosis of tendon injuries in the child too young to cooperate was not difficult provided careful observations of the posture of the hand were interpreted properly. In the young child, nerve injuries could be suspected by the location of the surface wound. However, the absolute identity of nerve interruption had to be confirmed at the time of the operative procedure. The secondary procedures included tendon grafts within the flexor sheaths of the fingers and thumb, and repairs of multiple nerve and tendon injuries in the palm. Thirty-four children had tendon grafts inserted into the fingers. Of the latter group, 65 per cent were less than six years of age. Seven patients had tendon grafts of the thumb and fifteen had secondary repairs for injuries in the palm. Although the structures are smaller in the child's hands, the operative procedure was often less difficult than in the adult hand. In the majority of the cases, the interphalangeal joints were supple and scarring was less than in the older patients. In most of the children the long extensor tendon of a toe was used for grafting. The maintenance of postoperative immobilization of the hand challenged us frequently in the child under six years. In the child too young to cooperate, suture removal was carried out under general anaesthesia. Formal physical therapy was not prescribed for children. Follow-up examinations were continued at yearly intervals in many of the young children before the end result could be ascertained. Fifty-three children were included in the follow-up study. In children of different ages, the variance in hand size precluded the use of measurements other than degrees of active and passive motion. The influence of the preoperative condition of the hand upon the result following tendon reconstruction should be stressed. Excellent results following tendon repair in children were determined according to criteria set for older patients. However, lesser stages of functional return were assessed with more difficulty. In fifty-three patients, twenty-three excellent and eighteen good results were obtained after either primary or secondary tendon and nerve reconstruction on the flexor surface of the hand.