Open flexor tendon injuries are very common, and the source of considerable disability. Prognosis is strongly influenced by the location of tendon injury (Fig. 23), with worst results anticipated for injuries in zone 2 In this zone, the profundus and superficialis tendons are tightly constrained within the flexor tendon sheath from the metacarpophalangeal joint to the mid-middle phalanx. As noted above, outcome is also markedly worse when tendon injury is associated with fracture or nerve injury. Tendon repairs require special suture technique, generally a combination of a central "core" suture or sutures and a peripheral epitendinous suture (Fig. 24). Suture technique is critical, and there is a strong ongoing trend to increase the number of core sutures such that four, six or more suture strands cross the tendon repair site. This trend is matc hed by a trend in postoperative management away from immobilization, currently using early controlled motion, but moving toward early active motion. Noting this, current postoperative management would involve - for the unreliable patient: immobilize in wrist and metacarpophalangeal joint flexion; and - for the cooperative patient: begin early controlled motion with elastic traction to passively flex the fingers while allowing active extension against resistance.
Flexor Tendon Injuries