title: Flexor tendon repairs in children: Outcomes from a specialist tertiary centre.
abstract: We evaluate the functional outcomes of early active mobilization (EAM) after paediatric flexor tendon repair at one centre from 2006 to 2013. A generic rehabilitation protocol was used for the first four to six weeks: boxing glove immobilization (<5 years), dorsal blocking splint and cage (5-10 years) or dorsal blocking splint ± cage (10-16 years). Outcomes were assessed using the Total Active Mobilization (TAM) method of the American Society for Surgery of the Hand and original Strickland criteria (OSC). Sixty-three fingers and 99 tendons were identified, in 57 children. Thirty-five per cent (n = 20) were in zone 2, 23% in zone 1, 18% in zone 5, 14% in zone 3 and 2% in zone 4. Good/excellent results were obtained in 82% by the TAM method and 79% by the OSC of those suitable for analysis (56 tendons in 44 children). The surgical approaches used varied in technique and material; a modified Kessler stitch (n = 42) using prolene (n = 60) represented the majority of core sutures. Epitendinous repair was employed in 76% of repairs (n = 75). The median length of hand therapy follow-up was 83.5 days (IQR 43.5-143.75 days). Complications included: one rupture, one post-operative infection requiring washout and three contractures, two requiring re-operation. EAM is a practical and safe way to rehabilitate children after flexor tendon repair, without increasing ruptures or adhesions. Most children under five are managed effectively in a bulky bandage.
authors.affiliation: Plastic Surgery Department, Royal Free Hospital, Pond Street, London, NW3 2QG, UK. Electronic address: lillicooper@doctors.org.uk.
authors.forename: L
authors.initials: L
authors.lastname: Cooper
authors.affiliation: Plastic Surgery Department, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
authors.forename: W
authors.initials: W
authors.lastname: Khor
authors.affiliation: Plastic Surgery Department, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
authors.forename: N
authors.initials: N
authors.lastname: Burr
authors.affiliation: Plastic Surgery Department, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
authors.forename: B
authors.initials: B
authors.lastname: Sivakumar
mesh_terms: D000293:Adolescent; D001458:Bandages; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000209:etiology; D005260:Female; D005383:Finger Injuries / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery*; D005385:Fingers / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011182:Postoperative Care; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D020127:Recovery of Function; D012086:Reoperation; D012421:Rupture / Q000601:surgery; D013165:Splints; D013530:Surgical Wound Infection / Q000209:etiology; D013536:Suture Techniques; D013708:Tendon Injuries / Q000503:physiopathology / Q000534:rehabilitation* / Q000601:surgery*; D013710:Tendons / Q000503:physiopathology / Q000601:surgery; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Children; Early active mobilization; Flexor tendon repair; Primary; Rehabilitation