Management of old flexor tendon injury in ‘no man`s land zone` using two-stage Hunter`s rod technique: case report

Abstract

Introduction: Flexor tendons of the wrist are divided into five anatomical zones. Zone II has the poor­est prognosis and highest probability of adhesions after repair, especially when there is significant la­tency between the trauma event and the medical help provided. Therefore, management of old full-width flexor tendon lesions are a significant orthopaedic problem. Materials and methods: A 32 years old man sustained a cutting trauma with a knife two months be­fore visiting a specialist. The patient complains of inability to flex his fifth finger on the right hand. During the physical examination it was determined that (flexor digitorum profundus) FDP tendon was lacerated. Considering the time of the event, a decision for a two-staged reconstruction with au­tograft was taken. Results: For the first stage of the operation, a zigzag operative approach was used. A solid silicon rod was inserted in the place of the lacerated tendon. The rod was then attached to the distal phalanx, thereafter the wound was closed and the finger left the extension. Two months later on the second stage, a tendon autograft from the patient`s palmaris longus muscle was used to take the place of the rod and reattached to the distal fifth phalanx and FDP on the fourth finger. The patient followed a re­habilitation programme for 3 months, until observing a good functional outcome. Conclusion. Dealing with old flexor tendon lesions in ‘no man`s land zone` can be notoriously diffi­cult and leading to poor functional outcome. In this case, the technique gave a good chance of regain­ing satisfactory function, considering the time passed since the trauma and the tendons` status. Con­clusively we can way this operative treatment offers significant benefits over the non-operative alter­natives.