[Zone I and II flexor tendon laceration in children].
OBJECTIVE
The goals of this study is to determine the effect of post-operative management as optimun period of post-operative immobilization, type of immobilization and importance of early mobilization program in zone I and II flexor tendon laceration in children.


METHODS
Thirty-seven patients who had sustained flexor tendon lacerations of 42 digits in zone I or II were available for critical evaluation. Inclusion criteria were primary flexor tendon repairs in children under 15 years: lesions of flexor pollicis longus, digits with crush injuries, skin loss or revascularization were omitted from this study. The average post-operative follow-up was 3 years (range 12-89 months). Flexor tendon repair had been performed on 9 index, 14 middle, 9 ring and 10 small fingers. Tendon laceration occurred in zone I in 16 fingers, zone II in 26. Patients were divided into three groups: 0 to 5 years, 5 to 10 years and 11 to 15 years.


METHODS
Immediate primary suture with modified Kessler technique was performed on the day of injury. Post-operative treatment included the use of an early passive motion program in 11 digits. The remaining 31 digits were managed by immobilization in a cast or splint for 4-6 weeks without early mobilization. The percentage of normal digital function that was recovered following flexor tendon repair was determined by a computation of total active motion (TAM) as described by Glogovac and Strickland (TAM = PIP active flexion + DIP active flexion-extension deficit/175). Data were analysed to determine the effect of age, the effect of early passive motion program, the effect of varying periods of post repair immobilization and the effect of the type of immobilization.


RESULTS
Tendon ruptures were identified in four digits. One was in a non cooperative patient who removed splint immobilization after two weeks post-repair. The three remaining patients were immobilized with a short splint. Isolated or combined profundus and superficialis repairs achieved comparable results when managed with an early passive motion or with simple immobilization without early motion program. Immobilization for 5 or 6 weeks resulted in an appreciable deterioration of function (TAM = 86 p. 100) in comparison with 4 weeks immobilization (TAM = 93 p. 100) (p > 0.05). Complication rate as rupture is higher in the group immobilized with a short splint, especially when children is under five.


CONCLUSIONS
Primary flexor tendon repairs in children in this series achieved satisfactory functional results in comparison with adults. There is however, in the very young, some widely differing results since the necessity of post operative care was not fully appreciated. Immobilization with a short splint should be avoided because of greater complication rate as rupture, especially in very young. We found no benefit of early passive mobilization protocols. Immobilization should not be extend beyond 4 weeks because of deterioration of final functional result.
Fitoussi
F
F
Service de Chirurgie Orthopédique, Hôpital Robert Debré, Paris.
Lebellec
Y
Y
Frajman
J M
JM
Penneçot
G
G
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005383:Finger Injuries / Q000628:therapy*; D005384:Finger Joint; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization; D007223:Infant; D011182:Postoperative Care; D013708:Tendon Injuries / Q000628:therapy*