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 Children�s 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 (n=32) 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 (n=13) 2-strand core suture (n=8) 5 additional patients

7. subjective results: function active mobilization (n=32) immobilization (n=13)

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% (p=0.109) 3 out of 10 2-strand repairs ruptured 1 direct re-repair 1 free tendon graft 1 pending

9. results (n=47 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