Zone I and II flexor tendon laceration in children

Aim of the study The goals of this study is to determine the effect of post -operative management as optimum period of post-operative immobilization, t ype of immobilization and importance of early mobilization program in zone I and II flexor tendon laceration in children. Material Thirty-seven patients who had sustained flexor tendon lacerations of 42 digits in zone I or ii were available for critical evaluation. Inclus ion criteria were primary flexor tendon repairs in children under 15 years: lesions of flexor pollicis longus, digits with crush injuries, skin loss o r revascularization were omitted from this study. The average post-operativ e follow-up was 3 years (range 12-89 months). Flexor tendon repair had been performed on 9 index, 14 middle, 9 ring and 10 small fingers. Tendon lacer ation occurred in zone I in 16 fingers, zone II in 26. Patients were divide d into three groups: 0 to 5 years, 5 to 10 years and 11 to 15 years. Methods Immediate primary suture with modified Kessler technique was perfor med on the day of injury. Post-operative treatment included the use of an e arly passive motion program in 11 digits. The remaining 31 digits were mana ged by immobilization in a cast or splint for 4-6 weeks without early mobil ization. The percentage of normal digital function that was recovered follo wing flexor tendon repair was determined by a computation of total active m otion (TAM) as described by Glogovac and Strickland (TAM = PIP active flexi on + DIP active flexion-extension deficit/175). Data were analysed to deter mine the effect of age, the effect of early passive motion program, the eff ect of varying periods of post repair immobilization and the effect of the type of immobilization. Results Tendon ruptures were identified in four digits. One was in a non co operative patient who removed splint immobilization after two weeks past-re pair. The three remaining patients were immobilized with a short splint. Isolated or combined profundus and superficialis repairs achieved comparabl e results when managed with an early passive motion or with simple immobili zation without early motion program. Immobilization for 5 or 6 weeks resulted in an appreciable deterioration of function (TAM = 86 p. 100) in comparizon with 4 weeks immobilization (TAM = 93 p. 100) (p > 0.05). Complication rate as rupture is higher in the group immobilized with a shor t splint, especially when children is under five. Discussion Primary flexor tendon repairs in children in this series achieve d satisfactory functional results in comparizon with adults. There is howev er, in the very young, some widely differing results since the necessity of post operative care was not fully appreciated. Immobilization with a short splint should be avoided because of greater complication rate as rupture, especially in very young. We found no benefit of early passive mobilization protocols. Immobilization should not be extend beyond 4 weeks because of d eterioration of final functional result.