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Flexor Tendon Injuries
Posted: Jun 1 2020 #(C101485)
A

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

PE

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%
377/980
Xrays
16%
157/980
CT hand (CT)
0%
5/980
MRI hand (MRI)
14%
140/980
Ultrasound (US)
10%
102/980
Xrays + CT
0%
3/980
Xrays + MRI
9%
89/980
Xrays + US
7%
69/980
Xrays + CT + MR
0%
3/980
Outside my area of expertise - best if I don't vote
3%
35/980
2. How would you manage this injury now that the patient is 4 months out from the original laceration?
Nonoperative
2%
20/939
Operative
93%
879/939
Outside my area of expertise - best if I don't vote
4%
40/939
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
0%
1/911
Debridement of tendon edges only
0%
5/911
Flexor tendon Repair (Repair)
45%
414/911
Flexor tendon Reconstruction (Reconstruction)
48%
444/911
Outside my area of expertise - best if I dont vote
5%
47/911
4. If you choose Flexor tendon Repair, what type of repair would you perform?
I would not choose Flexor tendon repair
12%
111/879
Epitendinous suture repair only
1%
13/879
Core suture only
6%
59/879
Epitendinous suture repair + Core suture repair
71%
626/879
Outside my area of expertise - best if I dont vote
7%
70/879
5. If you choose Core suture repair, how many strands would you cross the repair site?
I would not choose Core suture repair
3%
31/816
2 strands
13%
110/816
4 strands
47%
390/816
6 strands
19%
157/816
8 strands
6%
54/816
10 strands
0%
2/816
Outside my area of expertise - best if I dont vote
8%
72/816
6. If you choose Operative Treatment, what type of anesthesia would you perform?
I would not choose Operative Managment
0%
1/841
Wide awake (tumescent local anesthesia)
22%
188/841
Peripheral nerve block with sedation
29%
244/841
Peripheral nerve block without sedation
16%
138/841
General anesthesia
27%
233/841
Outside my area of expertise - best if I don't vote
4%
37/841
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
2%
18/817
Day 1-2
20%
169/817
Day 3-5
35%
289/817
Day 6-9
15%
126/817
Day 10-15
19%
163/817
Outside my area of expertise - best if I don't vote
6%
52/817
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
1%
14/770
ORIGINAL DURAN (low force/low excursion, extension block brace to PIP joints)
7%
60/770
MODIFIED DURAN (low force/low excursion, dorsal protective splint to finger tips)
31%
246/770
KLEINERT (low force/low excursion, + rubber band flexion)
22%
177/770
MAYO Synergistic Splint (low force/high excursion, + active wrist motion)
7%
54/770
SAINT JOHN (half-a-fist protected true active finger flexion)
6%
51/770
Other Early Mobilization Protocol
6%
50/770
Outside my area of expertise - best if I don't vote
15%
118/770
PROCEDURE #1

Direct FDP repairs of left middle, ring and small fingers

icon
OUTCOMES
Post-procedure P1
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