Traitement par suture directe des ruptures de poulies chez le grimpeur de haut niveau avec rééducation active postopératoire

Abstract

Closed traumatic rupture of the finger flexor tendon pulleys is rare among the general population but is seen much more commonly in rock climbers. There is no evidence-based published guidelines on the surgical treatment of these on closed traumatic ruptures of finger flexor pulleys which still presents difficult challenges. Different surgical repair options exist based on the use of grafted material to replace the ruptured pulley or pulleys, but direct repair has never been presented as an option. In this study, we retrospectively reviewed 8 cases of closed traumatic rupture of the flexor tendon pulley with simple repair and active re-education postoperative in high level rock climbers. Eight high level rock climbers were operated on between July 2015 and July 2018 for complete flexor tendon pulley ruptures. Postoperative improvement was evaluated by rock climber level, compared to the initial level. We performed a direct repair of the injured pulley with 4/0 absorbable separated sutures. An ultrasound examination of the sutured pulley was performed for 3 patients after 3 years postoperative. The average time of surgery was 16 minutes on average (range: 13–25 minutes). According to the Buck-Gramcko score, all injured fingers showed an excellent result. Finger diameter, Functional gene and JAMAR have been evaluated. They regained their climbing level after 5.8 months on average (range: 3–8 months). The ultrasound found 3 patients with pulley continuity and solid during their movements. Simple suturing of flexor tendon pulley in high level rock climbing and active re-education postoperative seems to be an alternative surgical treatment in acute situation.