Flexor tendon injuries in children: Rehabilitative options and confounding factors

Flexor Tendon Injuries in the Pediatric Population

Flexor tendon injuries are rare in children, posing specific diagnostic and therapeutic challenges. This study aims to describe epidemiologic characteristics of flexor tendon injuries in children and evaluate the outcomes of surgical treatment. We conducted a retrospective study of patients with acute traumatic flexor tendon injuries treated between 2012 and 2019. We analyzed demographics, lesion mechanism, surgical technique, clinical results, complications, and secondary surgical procedures. Functional results were assessed through the Total Active Mobilization score. Twenty patients were included (n=34 tendons), with median follow-up of 7 months (range, 3-34 months) and median age at time of surgery of 13 years (range, 1-17 years). Male sex was predominant (n=16). The most prevalent injury mechanism was a cut (n=17), mostly affecting the 4th digit (n=10) and Verdan's zone II (n=13). Modified Kessler was the suture technique most commonly used (n=31), and polypropylene was the preferred suture material (n=19). All patients were immobilized with a splint for a median time of 4 weeks (range, 1-7 weeks). According to the Total Active Mobilization score, 15 patients reached a score greater than 75%, independently of age (P>.05). Stiffness was the main complication observed. Complications were identified in 37% of patients and were most common in those older than age 10 years (P>.05) and those with zone II lesions (P>.05). Four patients (20%) needed a second surgical intervention. Flexor tendon injuries in children are relatively uncommon and prevail in the male sex, similarly to the adult population. The principal complication observed was stiffness, which was more prevalent in children older than age 10 years, although without relevant functional implications, as surgical treatment enabled good or excellent outcomes in 75% of patients. [Orthopedics. 2023;46(2):82-85.].

Effect of hand dominance on functional outcomes in paediatric patients with flexor tendon injuries: A cross-sectional study

INTRODUCTION

There are limited data in the literature about the short- to mid-term results of children with flexor tendon injuries. We aim to evaluate the short- to mid-term functional outcomes of children with flexor tendon injuries and to disclose whether the injured side affects the results.

MATERIALS AND METHODS

Patients who had undergone primary flexor tendon repair were included in the study. The demographic and clinical characteristics of the patients were recorded. Modified Hand Injury Severity Score was calculated for each patient. Sensory, motor and functional assessments of the bilateral hand were performed.

RESULTS

A total of 44 patients (female = 16, male = 28) with a median age of 13 (6-17) were evaluated. Significant differences between the affected and healthy hands of the patients in terms of grip and pinch strengths and monofilament sensory test results were demonstrated while the Jebson Taylor Hand Function Test (JTHFT) scores were similar. No factor other than the injury side was found to be related to the affected hand functions. In patients with dominant hand injuries, JTHFT results of the affected hands were similar to the results of healthy dominant hands (P = .935). However, JTHFT results were found to be worse in the affected non-dominant hands compared to healthy non-dominant hands (P = .01).

CONCLUSION

This study demonstrated that paediatric population with flexor tendon injuries in their dominant hands has better short- to mid-term functional outcomes. These results may be attributed to use their injured dominant hand more actively in daily activities.