Repair of the Flexor Pollicis Longus Tendon in Infant

Abstract

The author presents the case report of the rare for infant injury - the laceration of flexor pollicis longus tendon, which requires decisions on some complex questions relating to optimal tendon suture, suture material, type and duration of immobilisation, and the protocol for post-operative management.

A case report of a high bifurcation of the median nerve

“…В области локтевого нерва выявлено небольшое повреждение эпиневрия. Поврежденные сухожилия восстановлены петлевым швом Tsuge в нашей модификации нитью Tendo-Loop 3/0 (B. Вraun) [3,4]. Адаптирующие швы наложены нитью Prolen 4/0 (Ethicon).…”

Flexor tendon injuries in the child

“…There are only a few reports in English that specifically investigate the results of flexor pollicis longus repair in children (Fitoussi et al, 2000; Grobbelaar and Hudson, 1995; Orhun et al, 1999; Zolotov, 2008). The same principles mentioned for repairs of the profundus tendon apply for the long flexor of the thumb.…”

“…The risk of repair rupture within the cast may be reduced significantly by using an above-elbow cast, with the elbow in 120° of flexion, the forearm in supination, the wrist and fingers in flexion, and the palm filled with soft Webril wool (Covidien, Mansfield, MA, USA). Many paediatric hand surgeons apply a ‘pulp to palm’ suture before applying the cast (Kato et al, 2002; Kavouksorian and Noone, 1982; Zolotov, 2008). The suture is thought to decrease the ‘inadvertent grasping’ but there is no scientific evidence to support this.…”

“…This may result in rupture of the repaired tendon at 3-4 weeks. Hence, Zolotov (2008) recommends a protective splint between physiotherapy sessions in toddlers and infants for an additional 2 weeks after removal of the cast. Tuzuner et al (2004) reported a series of seven young children (less than 6 years old) with flexor tendon repair in Zone II.…”