MEDLINE Abstracts: Flexor and Extensor Tendon Injuries of the Hand

June 06, 2002

MEDLINE Abstracts: Flexor and Extensor Tendon Injuries of the Hand

What's new concerning tendon injuries of the hand? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Orthopaedics and Sports Medicine.

Chamay A
Annales de Chirurgie de la Main et du Membre Superieur 16(1):9-15, 1997

Flexor tendon injuries were already treated in antiquity by Hippocrates, Galien and Avicenne. Since the Renaissance, other surgeons have attempted to repair flexor tendon injuries, but without success due to problems related to unsuitable materials and ignorance of the basic rules of asepsis and the absence of antiseptics until the second half of the 19th century. The first successful flexor tendon grafts in man were performed by K. Biesalski in 1910, E. Lexer in 1912 and L. Mayer in 1916. These three authors published their series of grafts and described in detail the anatomical, physiological and technical principles to be respected. St. Bunnell, in 1918, developed various pull-out direct suture procedures, but faced with the problems of adhesions, he abandoned this technique and proposed not to repair flexors in the digital tunnels but to graft them. He defined the famous zone which he called No man's land, which subsequently became Claude Verdan's zone II, in 1959. In 1960, C. Verdan published his first series of sutures maintained by 2 pins in zone II with comparable results to those obtained after grafting. In 1967, H. Kleinert, with his mobile suture, became the leader of direct tendon repair in zone II. 2-stage grafts were introduced in 1965 under the impetus of J. Hunter, who revised and popularized the studies conducted by A. Bassett and R.E. Caroll in 1950.

Peck FH, Bucher CA, Watson JS, Roe A
Journal of Hand Surgery - British Volume 23(1):41-5, 1998 Feb

This prospective study compares subjects following primary repair of flexor tendons in zone 2 using either controlled active motion or a modified Kleinert regime. A matched pairs design was employed, subjects being matched for gender, age and injury characteristics. Twenty-six pairs of subjects with 92 tendon injuries in 52 digits were assessed 12 weeks postoperatively in respect of range of motion and dehiscence. Outcomes were defined using the Strickland criteria. No statistically significant differences in respect of range of motion were demonstrated between the groups. Incidence of rupture, however, was significantly less in the modified Kleinert group (7.7%) than in the controlled active motion group (46%).

Brug E
Unfallchirurg 100(8):602-12, 1997 Aug

The repair of interrupted flexor tendons of the hand and their return to satisfactory function has been one of the most difficult and challenging tasks and problems even for the hand surgeon. Accordingly, nearly all publications have dealt with suture techniques, suture material and even the number of knots with regard to vascularization, course of sheaths and biology of healing. The aim of all surgical intentions is intrinsic healing, with as few adhesions as possible. On the one hand, this requires non-traumatic treatment of the tendon, respecting the dorsally located blood support and, on the other, early motion, jeopardizing the continuity of sutures. These diametrical requirements are the crux of flexor tendon surgery. Many authors-including-prefer a combination of Kleinerts intratendinously knotted suture with Ikuta's technique with the knot sunk below the tendon surface. Closure of the severed sheath is recommended, as is reconstruction of both tendons, provided that both are injured. The repair of partial lacerations is different, however. Kleinert's early motion treatment in the rubber-hand-protected flexion position is the postoperative management that has the most acceptance. In two consecutive follow-up studies (1974-1987 and 1988-1994) of 253 patients with 348 injured fingers, we achieved excellent and good results in 84.8% in the earlier group and in only 80.3% in the later one, which involved more surgeons with varying amounts of experience in hand surgery.

Ip WY, Chow SP
Journal of Hand Surgery - British Volume 22(2):283-7, 1997 Apr

We report a prospective study of dynamic splintage following extensor tendon repair. Eighty-four patients with 101 extensor tendon injuries were studied. Using Dargan's evaluation system, there were 97% excellent results for the thumb and 93% excellent and good results for the fingers. The average total active motions were 107 degrees for thumbs and 245 degrees for fingers. Over 80% of patients regained good power grip. Patients with associated digital fractures or with ragged lacerations had poorer results. Overall, we found that dynamic splintage was a satisfactory method after extensor repair.

Peck FH, Bucher CA, Watson SJ, Roe AE
Journal of Hand Therapy 9(4):306-8, 1996 Oct-Dec

This paper reports the results of a one-year audit of flexor tendon injuries in zone II managed in a controlled mobilization program. It discusses the rationale for the use of this program and compares results with those of other units. On the basis of these results, the authors suggest that rehabilitation programs for patients with this type of injury should be tailored to individual needs and that trends in management should be carefully evaluated before implementation.

Baktir A, Turk CY, Kabak S, Sahin V, Kardas Y
Journal of Hand Surgery - British Volume 21(5):624-8, 1996 Oct

The results following primary and delayed primary repair in zone 2 flexor tendon injuries were evaluated prospectively in 88 fingers of 71 patients using two different early postoperative mobilization programmes. In 33 patients, the Kleinert rubber band passive flexion method was used. In the remaining 38 patients, the early active mobilization programme was used. All patients were reviewed 1 year after operation and the results assessed by the Strickland criteria. During this evaluation maximum grip strength was also measured. The results were excellent or good in 78% of digits and mean grip strength was 84% of the uninjured hand in the Kleinert rubber band passive flexion group. In the early active mobilization group, excellent or good results were achieved in 85% of the digits and the mean grip strength was 90% of the uninjured hand. There were two early ruptures in each group.

Evans RB
Hand Clinics 11(3):483-512, 1995 Aug

Postoperative management of the extensor tendon injury has been altered over the past 15 years from treatment with 4 to 6 weeks of immobilization to controlled passive motion and, now, to active SAM with minimal tension and wrist tenodesis programs. The concepts of immediate motion are supported biochemically in experimental studies, and biomechanically through excursion studies, mathematical analysis of tendon excursion and force application, and study of repair tensile strengths. The results cited in this article and those reported by others demonstrate that early motion for extensor tendons in zones III, IV, V, VI, VII, T IV, and T V is safe and effective if force application is precise. Early referral to therapy, meticulous care in the control of edema, precise positions of postoperative splinting, and controlled motion programs will greatly improve the results of both simple and complex extensor tendon injuries, both in terms of function achieved and in terms of time and expense.