Posted: Jun 1 2020 #(C101485)

Chronic Zone 1 Flexor Tendon Lacerations in 17M

HPI

A 17-year-old male presents with a history of a sharp laceration in Zone I of his left middle, ring, and small fingers 4 months prior. He was told "everything was fine" at an outside hospital. He now presents 4 months after the injury with no flexion at the DIP joint on the left middle, ring, and small digit. He has no past medical or surgical history.

PMH

No past medical or surgical history

On physical exam he has a transverse scars on the volar middle, ring and small fingers just proximal to level of DIP joints. He has no flexion at the DIP joints. His neurovascular exam is intact.

Poll

1 of 8

1. Considering his flexion deficit on physical exam, what imaging studies would you require to determine treatment?

None - physical exam alone is enough

38%

375/967

Xrays

15%

151/967

CT hand (CT)

5/967

MRI hand (MRI)

14%

140/967

Ultrasound (US)

10%

102/967

Xrays + CT

3/967

Xrays + MRI

87/967

Xrays + US

66/967

Xrays + CT + MR

3/967

Outside my area of expertise - best if I don't vote

35/967

2. How would you manage this injury now that the patient is 4 months out from the original laceration?

Nonoperative

20/926

Operative

93%

867/926

Outside my area of expertise - best if I don't vote

39/926

3. If you choose Operative Management and intraoperatively found 100% rupture with proximal tendon retraction to roughly the level of the PIP joints (see first image), how would you treat this injury?

I would not choose Operative Managment

1/899

Debridement of tendon edges only

5/899

Flexor tendon Repair (Repair)

45%

413/899

Flexor tendon Reconstruction (Reconstruction)

48%

435/899

Outside my area of expertise - best if I dont vote

45/899

4. If you choose Flexor tendon Repair, what type of repair would you perform?

I would not choose Flexor tendon repair

12%

109/868

Epitendinous suture repair only

13/868

Core suture only

58/868

Epitendinous suture repair + Core suture repair

71%

618/868

Outside my area of expertise - best if I dont vote

70/868

5. If you choose Core suture repair, how many strands would you cross the repair site?

I would not choose Core suture repair

31/805

2 strands

13%

110/805

4 strands

47%

386/805

6 strands

18%

150/805

8 strands

54/805

10 strands

2/805

Outside my area of expertise - best if I dont vote

72/805

6. If you choose Operative Treatment, what type of anesthesia would you perform?

I would not choose Operative Managment

1/830

Wide awake (tumescent local anesthesia)

21%

182/830

Peripheral nerve block with sedation

29%

243/830

Peripheral nerve block without sedation

16%

137/830

General anesthesia

27%

231/830

Outside my area of expertise - best if I don't vote

36/830

7. If you choose Epitendinous and/or Core Suture repair, when would begin your passive ROM protocol under therapist guidance?

I would not choose Epitendinous and/or Core Suture repair Repair

18/805

Day 1-2

20%

168/805

Day 3-5

34%

279/805

Day 6-9

15%

125/805

Day 10-15

20%

163/805

Outside my area of expertise - best if I don't vote

52/805

8. If you choose Epitendinous and/or Core Suture repair, what type of ROM protocol would you use?

I would not choose Epitendinous and/or Core Suture repair Repair

13/758

ORIGINAL DURAN (low force/low excursion, extension block brace to PIP joints)

58/758

MODIFIED DURAN (low force/low excursion, dorsal protective splint to finger tips)

31%

241/758

KLEINERT (low force/low excursion, + rubber band flexion)

23%

176/758

MAYO Synergistic Splint (low force/high excursion, + active wrist motion)

53/758

SAINT JOHN (half-a-fist protected true active finger flexion)

51/758

Other Early Mobilization Protocol

49/758

Outside my area of expertise - best if I don't vote

15%

117/758

Post-procedure P1

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