The evidence-base for the management of flexor tendon injuries of the hand: Review

Ishak, Athanasius; Rajangam, Akshaya; Khajuria, Ankur

doi:10.1016/j.amsu.2019.10.006

Cited by 28 publications

(17 citation statements)

References 73 publications

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“…The technique used for the control group, 4-core strand suture with a peripheral suture, has been debated to be the gold standard that allow optimal balance between repair strength, time of procedure, and also allows for quick rehabilitation [3,5,7,17]. With the traditional repair, rupture occurred at the knot level, compatible with prior evidence [3,6].…”

Section: Discussionmentioning

confidence: 98%

“…Flexor tendon injuries of the hand, especially in zone 2, account for less than 1% of all hand injuries, but are di cult to treat and are associated with poor outcome [1]. While major progress has been made with the treatment of these injuries, current surgical treatment relies mostly on conventional suturing techniques with dissatisfactory results, concluding in re-operation rates of 6%-17%, and complication rate of up to 20% [1][2][3][4][5]. Furthermore, a considerable wide diversity in suturing techniques used by different health providers, might imply a superior technique has yet to be discovered [1,4,6,7].…”

Section: Introductionmentioning

confidence: 99%

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Dynamic Tendon Grip (DTG™) Novel Knot Array Compared to Traditional Sutures for Zone Two Flexor Tendon Injury – A Biomechanical Study

Kadar

Fainzack

Vigler

2021

Preprint

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BackgroundFlexor tendon injuries pose many challenges for the treating surgeon, the principal of which is creating a strong enough repair to allow early active motion, preserving a low-profile of the repair to prevent buckling and subsequent pulley venting. A main concern is that a low-profile repair is prone to gap formation and repair failure. The Dynamic Tendon Grip (DTG™) all suture staple device claims to allow a strong and low-profile repair of the flexor tendon. The purpose of this study is to test the effects of the DTG™ device in early active motion simulation on range of motion, load to failure and gap formation and to compare it to traditional suturing technique. MethodsTwelve fresh-frozen cadaveric fingers were assigned to two groups: DTG™ device (n=9) and traditional suturing (double Kessler 4-core suture and a peripheral suture, n=3). The deep flexor was incised and repaired in zone 2, and active motion simulation was carried out with a cyclic flexion-extension machine. Finger range of motion and gap formation were measured, as well as load to failure and method of repair failure. ResultsFollowing motion simulation, ROM decreased from 244.0 ± 9.9° to 234.5 ± 5.8° for the DTG™ device compared to 234.67 ± 6.51° to 211.67 ± 10.50° for traditional suturing. The DTG™ repair demonstrated gap formation of 0.93 ± 0.18 mm in 3 of 8 specimens after applying 1 kg load, which negated after load removal. Load to failure averaged 7.8 ± 2.36 kg for DTG™ and 6.76 ± 4.10 kg for the traditional repair. Repair failure occurred as the suture material broke for the DTG™ array and at the knot level for the traditional repair.ConclusionsThe DTG™ all-suture stapling concept achieved a strong low-profile repair in zone 2 flexor tendon injury after active motion simulation. Further clinical studies will be needed to determine the effectiveness of this device compared to traditional techniques.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Dynamic Tendon Grip (DTG™) Novel Knot Array Compared to Traditional Sutures for Zone Two Flexor Tendon Injury – A Biomechanical Study

Kadar

Fainzack

Vigler

2021

Preprint

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“…tendon grafts, tendon transfers, end-to-end repair and arthrodesis of interphalangeal joints, however, by any means a worse outcome has been reported compared to the usual flexor tendon injuries [ 5 ]. Flexor tendon ruptures after VLP fixation could be categorized in zone V tendon injuries, and there are few reports on the outcome of the zone V tendon repair [ 10 ]. Rubensson et al reported that the results of ROM after reconstruction with free tendon graft are as good enough as the previous reports about flexor tendon reconstructions [ 5 ], but the decision regarding which of the various techniques should be applied is possibly dependent on the condition of ruptured tendon stumps.…”

Section: Discussionmentioning

confidence: 99%

The sole rupture of flexor digitorum tendons to the index finger following volar locking plate fixation of distal radius fracture: A case report

Honoki

Nishida

et al. 2020

Trauma Case Reports

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Distal radius fracture is a common injury, especially in elderly people, and internal fixation with volar locking plate (VLP) is becoming an increasingly popular technique for the management of displaced and/or unstable distal radius fractures. One of the most common complications of this treatment is the flexor tendon rupture, mostly of the flexor pollicis longus (FPL). While the rupture of flexor digitorum tendons to the index (FDI) mostly occurs concomitantly with the rupture of FPL after the treatment using volar plating for distal radial fracture, sole rupture of the FDI without FPL rupture is very rare. Here, we report a case of the sole rupture of FDI after volar locking plating and analyze its pathogenesis indicating that the lift-up of the distal ulnar edge of the plate related to the malcorrection of the fracture site is the culprit for this specific complication.

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“…Advancement in surgical repair techniques and materials have enabled early active motion following flexor tendon repair, yet there is a lack of high-quality evidence to inform best practice for post-operative rehabilitation. [2][3][4][5] Existing systematic reviews exploring flexor tendon rehabilitation have assessed different approaches to splinting, for example including or excluding the wrist, 5 or different exercise programmes, for example passive or active mobilisation. 3,4,6 However, none of these reviews were able to draw firm conclusions.…”

Section: Introductionmentioning

confidence: 99%

Relative motion flexion splinting for the rehabilitation of flexor tendon repairs: A systematic review

Newington

Ross

Howell³

2021

Hand Therapy

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Introduction Relative motion splinting has been used successfully in the treatment of extensor tendon repairs and has recently been applied in flexor tendon rehabilitation. The purpose of this systematic review was to identify articles reporting use of relative motion flexion (RMF) splinting following flexor tendon repair and to examine indications for use and clinical outcomes. Methods Seven medical databases, four trials registries and three grey literature sources were systematically searched and screened against pre-specified eligibility criteria. Screening, data extraction and quality appraisal were independently performed by two reviewers. Results A total of 12 studies were identified, of which three met the review eligibility criteria: one retrospective case series; one cadaveric proof of concept study; and one ongoing prospective case series. The type of splint (including metacarpophalangeal joint position and available movement), exercise programme, and zone of tendon injury varied between studies. Both case series presented acceptable range of movement and grip strength outcomes. The prospective series reported one tendon rupture and two tenolysis procedures; the retrospective series reported no tendon ruptures or secondary surgeries. Discussion We found limited evidence supporting the use of RMF splinting in the rehabilitation of zones I-III flexor tendon repairs. Further prospective research with larger patient cohorts is required to assess the clinical outcomes, patient reported outcomes and safety of RMF splinting in comparison to other regimes. Application of the relative motion principles to flexor tendon splinting varied across the included studies, and we suggest an operational definition of relative motion in this context.

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The evidence-base for the management of flexor tendon injuries of the hand: Review

Cited by 28 publications

References 73 publications

Dynamic Tendon Grip (DTG™) Novel Knot Array Compared to Traditional Sutures for Zone Two Flexor Tendon Injury – A Biomechanical Study

Dynamic Tendon Grip (DTG™) Novel Knot Array Compared to Traditional Sutures for Zone Two Flexor Tendon Injury – A Biomechanical Study

The sole rupture of flexor digitorum tendons to the index finger following volar locking plate fixation of distal radius fracture: A case report

Relative motion flexion splinting for the rehabilitation of flexor tendon repairs: A systematic review

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