Functional outcomes of a modified Duran postoperative rehabilitation protocol after primary repairs of pediatric hand flexor tendon injuries

Abstract

The objective of this study was to determine whether pediatric patients undergoing flexor tendon repair who underwent 4 weeks of immobilization followed by a modified Duran controlled passive motion rehabilitation protocol will have favorable outcomes. A study was performed at a tertiary pediatric hospital of patients <18 years who underwent primary flexor tendon repairs in zones 1-4. Outcomes were calculated by total active motion and classified by the original Strickland criteria or Buck-Gramcko criteria. Twenty-eight patients with 34 injured fingers were included. Mean age was 11.4 years (range 2.4-17.9) with 17 males (61%) and 11 females (39%). Thirty-five percent of injuries occurred in zone 1; 35% zone 2; 6% zone 3; and 24% zone 4. All underwent a modified Duran postoperative rehabilitation protocol following a period of immobilization. The majority of patients achieved favorable outcomes, with 86% of cases classified as good/excellent. Thirty (88%) cases received surgery acutely (within 3 weeks). Of these, 70% achieved excellent outcomes, 17% good, and 13% fair. Four (12%) chronic cases underwent primary repair (range 24-68 days), achieving excellent outcomes in 50%, good in 25%, and fair in 25%. Three (75%) patients with delayed primary repair exhibited stiffness, which was greater than the 17% of patients with acute repairs ( P = 0.03). Approximately 1 month of immobilization followed by a modified Duran rehabilitation protocol leads to favorable outcomes in children with flexor tendon repairs. Children with delayed surgery (>3 weeks) who underwent primary repair generally still achieved good outcomes but were more likely to have stiffness. Level of evidence: III.