Özet:
Introduction: Flexor tendon injuries of the hand are common occurring these days and its management is still far from ideal. The
functional outcome of zone 2 flexor tendon injuries are not good in view of higher incidence of adhesion formation. Numerous
studies have been reported but yet nothing is deemed ideal.
Objective: This study was conducted to see the results of primary repair of zone 2 flexor tendon injuries with prolene suture and early
supervised aggressive mobilization and rehabilitation protocol.
Design: Prospective study (Level IV evidence) reporting case series.
Setting: Academic hospital associated with a medical college
Participants: All patients with isolated flexor tendon injuries in zone 2 of the hand.
Interventions: All tendons were repaired with prolene suture using standard operative procedures. Immediate splintage was done
with thermoplastic splints and hand kept in dorsal blocking of 20 degrees flexion at wrist and 75 degrees at metacarpophalangeal
joint. Rubber elastic springs were used for passive flexion which were fixed at nails and distal forearm. Early postoperative exercises
were started after 48 hours of repair under direct supervision with passive extension and flexion. Gradually active exercises were
added to the protocol. Finger splint was used for 4 weeks during whole day and after that it was used during night time only.
Outcome measures: Outcome (tendon excursion) was evaluated using Strickland evaluation system and categorized as excellent,
good, fair and poor.
Results: A total of 50 patients (males- 32; females- 18) with zone 2 flexor tendon injuries were included and analyzed. Overall 85.7%
digits had excellent or good results. Patients with single digit involvement had 94% excellent result in comparison to 31% in multiple
digit involvement group (p<0.0001; Chi Squared test). Patients in which only FDP was repaired had better results than cases who
had their both the tendons (FDP and FDS) repaired (90% vs 72%; p=0.1252, not significant). Most of the poor outcomes were found
in patients who had both the tendons (FDP and FDS) repaired.
Conclusion: While venturing in the no man’s land of flexor tendon injury one has to be very meticulous in surgical techniques with
appropriate use of suture material and early physiotherapy. Patients should be explained in detail regarding the protocol to be followed
prior to the surgical repair and repeatedly told after the surgery. Best results are achieved with early supervised physiotherapy either
by doctor or hand therapist.
