Flexor tendon repair with active motion program in children

1
Flexor tendon repair with active motion program
in children

• Y. Nietosvaara, N. Lindfors, S. Palmu
• N. Suojanen, S. Rautakorpi
• Childrens Hospital,
• Helsinki University Central Hospital

2
patients

• 28 consecutive children (2-15 year old)
• 7 girls and 21 boys
• 68 flexor tendons
• 45 fingers
• zone I 10, zone II 15, zone III 1, zone V 19
• associated nerve injuries in 15 children
• ND 9, NC 1, ulnar 4, median 2

3
tendon repair

• multi-strand in 33 fingers
• 4- or 6-strand core suture (Tendoloop or
  Ticron)
• 2-strand in 8 fingers
• pull-our refixation in 3 fingers
• free tendon graft in 1 finger

4
post-operative program

• thermoplastic splint for 6 weeks (n32)
• applied 1-3 days after tendon repair
• active exercises without the splint
• 5 repetitions four times a day
• follow-up at 1, 3, 5 and 7 weeks (OT)
• final follow-up at mean 3 years (1-6)
• cast immobilization (n13)
• 2-strand core suture (n8)
• 5 additional patients

5
protective thermoplastic splint
6
active extension
active flexion
7
subjective results function

• active mobilization (n32)
• immobilization (n13)

0
100
0
100
p 0.135
8
results (TAM)

• normal wrist motion
• mean MP TAM 100 (91-117)
• mean PIP TAM 98 (80-113)
• mean DIP TAM
• 2-strand (immo) 41 vs.
• multi-strand (active) 73 (p0.109)
• 3 out of 10 2-strand repairs ruptured
• 1 direct re-repair
• 1 free tendon graft
• 1 pending

9
results (n47 fingers)45 primary operations 2
repair for ruptures

• method E G F P
• Buck-Gramcko 46 1 0 0
• modified Strickland 35 10 0 0
• ASSH-TAM 19 21 5 0
• original Strickland 30 7 7 1
• DIP-TAM 28 5 3 11

10
conclusions

• multistrand flexor tendon repair with active
  motion program proved to be a reliable, patient
  and therapist friendly treatment protocol in
  children with good functional outcome