Zone I flexor profundus tendon repair in children 5-10 years of age using 3 "figure of eight" sutures followed by immediate active mobilization

Abstract

A review of the English medical literature over the last 20 years reporting on flexor profundus lacerations revealed only 55 reported cases of zone I flexor profundus lacerations in children. The standard repair technique in young children (5-10 years of age) has been either tendon reinsertion into bone (usually Bunnell technique) for distal zone I injuries or a 2-strand repair (usually modified Kessler technique) for proximal zone I injuries. We report on 22 children (5-10 years of age) with zone I flexor profundus tendon lacerations (10 children had distal zone I injury and 12 had proximal zone I injury) repaired with a 6-strand technique (3 separate "figure of 8" sutures) followed by early postoperative active mobilization. There were no ruptures. Using the Strickland and Glogovac criteria (on the basis of the net active motion of both the interphalangeal joints), all children qualified for an excellent outcome. However, using Moremen and Elliot criteria (on the basis of the net active motion of the distal interphalangeal joint only), 11 children had an excellent outcome, 3 had a good outcome, and 8 had a fair outcome. Our results were compared with previously reported series. It was concluded that the 6-strand figure of 8 suture technique may be used in pediatric zone I injuries and it is strong enough to allow safe early postoperative active mobilization in the 5- to 10-year age group children.