title: Functional outcome of flexor tendon repair of the hand at Zone 5 and post operative early mobilization of the fingers.
abstract: Objective : There are few reports on outcome following flexor tendon repair of the hand in zone 5. We hypothesized that early mobilization of the fingers is possible if the suture site of repaired tendon is strong enough. The aim of this study was to assess the results of flexor tendon repair in this zone using modified Kessler method reinforced by peripheral running suture and a post operative early active and passive mobilization of the fingers.
  
  
  METHODS
  This prospective study was carried out between April 2006 and Feb 2010, and 171 digits flexor tendons cut in 42 patients were repaired by modified Kessler technique reinforced by running peripheral suture. Early active mobilization and gentle passive motion of the fingers was allowed in a dorsal wrist splint the day after surgery. Wrist Immobilization was performed for one month. Function of the tendons was assessed by Buck-Gramcko score at nine month follow up.
  
  
  RESULTS
  Mean age of the patients was 25.4 years (range 17-46 y). Twenty nine flexor policis longus, 77 flexor digitorum superficialis and 65 flexor digitorum profundus tendons of digits were repaired. Middle and index fingers were most commonly involved. Median and ulnar nerve repair was done in 17 and 12 cases respectively. Good to excellent results were seen in of 79.34% of FPL and 74.65% of other finger flexors. One case of FPL rupture was seen. Tenolysis of FDS was performed in one case. Recovery in thenar muscle function was good, fair and poor in 5, 2 and 10 cases after median nerve repair, while all 12 patients with ulnar nerve lesion showed some degrees of clawing of 4(th) and 5(th) fingers. Conclusion : Most patients following flexor tendon repair at zone 5 obtained good results. Early motion of the fingers seems to improve outcome in these patients. Concomitant nerve cut in particular of ulnar nerve were associated with a high rate of poor results.
authors.affiliation: Seyed Abdolhossein Mehdi Nasab, Associate Professor, Department of Orthopaedic Surgery, Emam Khomeini Hospital, Musculoskeletal and Rehabilitation Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Seyed Abdolhossein
authors.initials: SA
authors.lastname: Mehdi Nasab
authors.affiliation: Nasser Sarrafan, Associate Professor, Department of Orthopaedic Surgery, Emam Khomeini Hospital, Musculoskeletal and Rehabilitation Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Nasser
authors.initials: N
authors.lastname: Sarrafan
authors.affiliation: Seyed Reza Saeidian, Assistant Professor, Dept. of Physical Medicine & Rehabilitation, Emam Khomeini Hospital, Musculoskeletal and Rehabilitation Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Seyed Reza
authors.initials: SR
authors.lastname: Saeidian
authors.affiliation: Hassan Emami, Resident, Department of Orthopaedic Surgery, Emam Khomeini Hospital, Musculoskeletal and Rehabilitation Research Center, Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Hassan
authors.initials: H
authors.lastname: Emami
keywords: Early Finger Mobilization; Flexor Tendon Injury; Hand Function; Kessler Technique; Zone 5