Mateusz Gładysz FESSH prep

FESSH prep Tendon injuries

Flexor tendon injuries in children

Last reviewed v1.0

FESSH-098Tendon injuries●●○ intermediate

Regarding flexor tendon injuries in children:

  1. 1.After zone II flexor tendon repair in children, immobilisation for longer than about 4 weeks was associated with poorer digital function than shorter immobilisation or early motion.

  2. 2.In children, an associated digital nerve injury does not influence the outcome of zone I–II flexor tendon repair.

  3. 3.In a randomised comparison in children younger than 4 years, four-strand zone 2 flexor repairs gave significantly greater active motion than two-strand repairs.

  4. 4.Pooled data on primary flexor tendon repair in children show mostly excellent or good functional results with few ruptures.

  5. 5.In a long-term series of children younger than 6 years, growth of the finger was commonly impaired after primary zone 2 flexor tendon repair.

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Question ID
FESSH-098
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. After zone II flexor tendon repair in children, immobilisation for longer than about 4 weeks was associated with poorer digital function than shorter immobilisation or early motion.

    True

    O'Connell's three-practice study of 95 digits in 78 children found comparable results in zone II after early passive motion or 3–4 weeks of immobilisation, whereas immobilisation for longer than 4 weeks led to an appreciable deterioration of function. With less than 4 weeks of immobilisation or early motion, results did not differ significantly between age groups.

    • O'Connell SJ, Moore MM, Strickland JW, Frazier GT, Dell PC. Results of zone I and zone II flexor tendon repairs in children. J Hand Surg Am. 1994;19(1):48-52. PMID 8169368

  2. 2. In children, an associated digital nerve injury does not influence the outcome of zone I–II flexor tendon repair.

    False

    Elhassan's series of 41 fingers found that isolated tendon repairs had better results than those with associated nerve repairs, and that zone I repairs did better than zone II repairs. O'Connell likewise found that digits with associated digital nerve or palmar plate lacerations fared less favourably than isolated tendon lacerations.

    • Elhassan B, Moran SL, Bravo C, Amadio P. Factors that influence the outcome of zone I and zone II flexor tendon repairs in children. J Hand Surg Am. 2006;31(10):1661-6. PMID 17145388
    • O'Connell SJ, Moore MM, Strickland JW, Frazier GT, Dell PC. Results of zone I and zone II flexor tendon repairs in children. J Hand Surg Am. 1994;19(1):48-52. PMID 8169368

  3. 3. In a randomised comparison in children younger than 4 years, four-strand zone 2 flexor repairs gave significantly greater active motion than two-strand repairs.

    False

    Navali randomised 32 zone 2 lacerations in 29 children under 4 years to two- or four-strand modified Strickland repairs. Mean total active motion was 156° and 158° respectively, with no significant difference; one two-strand repair ruptured within 3 weeks and no four-strand repair failed.

    • Navali AM, Rouhani A. Zone 2 flexor tendon repair in young children: a comparative study of four-strand versus two-strand repair. J Hand Surg Eur Vol. 2008;33(4):424-9. PMID 18687828

  4. 4. Pooled data on primary flexor tendon repair in children show mostly excellent or good functional results with few ruptures.

    True

    Huynh's systematic review of 20 studies (577 patients, 748 digits) reported outcomes for 466 digits, of which 306 were excellent and 132 good, with 15 tendon ruptures. Operative and rehabilitation protocols varied widely, so the evidence is of low level.

    • Huynh MN, Karir A, Kim PJ. A systematic review of patient outcomes for primary pediatric flexor tendon repairs. J Hand Microsurg. 2024;16(4):100062. PMID 39234382

  5. 5. In a long-term series of children younger than 6 years, growth of the finger was commonly impaired after primary zone 2 flexor tendon repair.

    False

    Kato reviewed 12 children younger than 6 years a mean of 8 years after zone 2 repair with above-elbow cast immobilisation: phalangeal length averaged 99% of normal (range 96–100%) and total active motion averaged 89%. O'Connell found that digital motion often improved modestly with growth.

    • Kato H, Minami A, Suenaga N, Iwasaki N, Kimura T. Long-term results after primary repairs of zone 2 flexor tendon lacerations in children younger than age 6 years. J Pediatr Orthop. 2002;22(6):732-5. PMID 12409897
    • O'Connell SJ, Moore MM, Strickland JW, Frazier GT, Dell PC. Results of zone I and zone II flexor tendon repairs in children. J Hand Surg Am. 1994;19(1):48-52. PMID 8169368