Sutures primitives des tendons fléchisseurs en zone II (103 doigts): Résultats et limites du « Kleinert

Abstract

One hundred and sixty-two instances of traumatic division of the flexor tendons in zone 2 occurring in 103 injured digits were studied in 88 patients with at least 6 months follow-up. Motion and sensibility studies as well as trophic evaluation were available for all patients. Sixty-eight patients underwent repair according to Kleinert's technique. Overall results in these cases showed a 58% rate of "satisfactory" results versus 34% when classic techniques had been employed (35 cases). Kleinert's technique afforded the highest percentage of "good" results (75%) when tendon division was isolated whereas the rate of "good" results dropped to 23% when the injury went through to the floor of the digital tunnel. Complications included joint stiffness due to adhesions (19%) mainly related to the magnitude of the initial trauma, fixed flexion deformities (15%) and secondary rupture of the tendon (7%). Excision of the superficial flexor tendon was invariably associated with a poor results. Secondary treatment of these lesions was disappointing. While we agree that Kleinert's operative technique be used whenever feasible, semipassive mobilization as indicated by Kleinert, should however be reserved for isolated lesions in cooperative patients treated in centers where closely supervised rehabilitation is available. Immobilization of the interphalangeal joints in flexion together with their separate passive mobilization according to the method of Duran and Strickland, may reduce the number of complications observed with Kleinert's technique in the following circumstances; severe lesions (groups 3 A, 3 B), inadequate healing, an uncooperative patient. It is of paramount importance to look for and repair concomitant nerve injuries. Inadequate nerve management alone in these circumstances can account for up to 25% of overall functional failures. When bilateral vascular lesions are present, it is essential that vascular repair of the digital arteries be performed at once. Unilateral arterial insult does not seem to significantly affect results in terms of active motility.