[Personal experience with injuries of the flexor tendons of the hand]

Abstract

Purpose of the study: The study presents a retrospective evaluation of a group of 198 patients with 242 acute injuries of tendons of flexors of the hand in the period between 1995-1999. Evaluation covers the outcomes of the primary treatment as compared to the secondary reconstruction surgery--mainly in zone II after Kleinert.

Material: The followed up group (242 injuries of flexor tendons) consisted of 79% of men and of 21% women. Hundred-and-twelve patients (46%) had the flexor tendon affected in zone II.

Methods: According to anatomical location the injuries were classified into five zones after Kleinert. Primary treatment in zone I consists in suture or reinsertion (after Bunnell), in zones II-V in suture. Primary treatment was performed within 24 hours, postponed primary treatment within 10 days. The surgery is performed by autraumatic suture in the operating theatre under strictly aseptic conditions. In case of the injury of the superficial and deep flexor we always treated both. At the same time suture or reconstruction of pulleys of flexor tendon sheaths was performed. The total number of reconstruction surgeries was 31 (re-suture, re-insertion, tenolysis, one- or two-step transplantation by means of tendon of the long palmar muscle); of this in zone I six surgeries, in zone II nineteen, in zone III two, in zone IV three and in zone V one surgery.

Results: The results are evaluated after the accomplished physical therapy according to the range of motion on the basis of the so called Louisville system based on the deficit of flexion and extension. In zones I, III, IV and V the result was excellent or good in 90% of patients after primary surgery and in 80% of patients after secondary operation. After primary suture in zone II excellent or good results were achieved in 80% of patients, after reconstruction surgery only in 63% of patients.

Discussion: The results show in accordance with all cited authors that the primary treatment provides a far better final effect of the treatment of flexor tendons of the hand than the reconstruction surgery, even though precisely performed.

Conclusion: Treatment of the flexor tendons of the hand should be performed as soon as possible with a full comfort for the patient (operating theatre, total or local anesthesia) as well as for the surgeon (assistance, perfect suture material). Reconstruction surgery is considerably less successful. In all zones after the primary surgery excellent or good results are at least by 10%, in zone II even by 16%, more frequent than in the secondary surgery.