Long-term outcome of paediatric flexor tendon injuries of the hand

Abstract

The ideal rehabilitation regimen of paediatric flexor tendon injuries of the hand is discussed controversially. In this study, the clinical outcome of paediatric patients with flexor tendon injuries treated with a dynamic postoperative protocol was assessed. All children with flexor tendon injuries of the hand who were treated by a dynamic postoperative protocol between 1999 and 2011 were included. Patients were invited for a follow-up examination consisting of clinical examination, the TAM and Buck-Gramcko scores, and the linear measurement system. In total, 144 patients (mean age 9.1 years, range 1-17 years) with 267 flexor tendon injuries (128 flexor digitorum superficialis (FDS), 126 flexor digitorum profundus (FDP) and 13 flexor pollicis longus (FPL)) of 191 digits were treated. Of them, 43% (n=62; 49 male, 13 female) with 88 digits (thumb n=4, index finger n=17, middle finger n=25, ring finger n=20, small finger n=22) with 123 injured tendons (FDS n=62, FDP n=57, FPL n=4) were included in the follow-up at a mean post-operative interval of 7.2 years (range 1-13 years). Using the Total Active Motion (TAM) score, an excellent and good outcome could be achieved in 41% and 48% of the patients, respectively. The zone of injury did not influence the objective outcome measures. Subjective and objective outcomes were not statistically different between young children (≤6 years) and older children (>6 years). The present study demonstrates good to excellent outcome in a large cohort of paediatric patients with flexor tendon injuries of the hand treated with a dynamic mobilisation protocol irrespective of patient age.