Diagnosis and Surgical Principles in the Treatment of Acute Injuries of the Flexor Tendons of the Hand
AJTES Vol. 5, No 2, July 2021.
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Keywords

flexor tendon
injury
injury zone
fist
deep
superficial

How to Cite

Georgieva, G., Jovanoski, T., Aliu, Z., & Djokic, D. (2021). Diagnosis and Surgical Principles in the Treatment of Acute Injuries of the Flexor Tendons of the Hand. Albanian Journal of Trauma and Emergency Surgery, 5(2), 869-873. https://doi.org/10.32391/ajtes.v5i2.226

Abstract

Injuries to the flexor tendons of the wrist are a separate chapter in wrist surgery. Flexor tendon injuries still remain a challenge to ensure the patient's optimal outcome.

A special problem in the exploration of hand injuries is the accurate assessment of whether there is an injury to one or more tendons, at what height the injury is, and whether it is accompanied by injury to other elements of the hand.

On the volar side of the hand, both flexors of the fingers, superficial and deep, or just one of them, maybe injured. If the lesion is in the first zone depending on the severity of the injury, reinsertion or direct tenography is required.

In the second zone, there are still ambiguous views on the reconstruction of the deep and superficial flexor, ie. whether the surface flexor needs to be reconstructed. Injury to the flexor tendons in the third zone requires careful exploration for possible injury to the neurovascular elements, and the fourth zone often requires the release of the carpal tunnel.

In the most proximal zone of the flexor tendons, the fifth zone, injury to the main blood vessels of the hand and the nerves responsible for sensitive and motor innervation of the hand is possible.

Each injury should be approached with careful preoperative examination, appropriate operative technique as well as postoperative rehabilitation in order to fully restore the function of the hand.

https://doi.org/10.32391/ajtes.v5i2.226
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References

Kannus P, Jozsa L, Jarvinnen M. Basic science of tendons. In: Garrett WE Jr, Speer KP, Kirkendall DT, editors. Principles and practice of orthopaedic sports medicine. Philadelphia: Lippincott Williams and Wilkins; 2000. pp. 21–37. [Google Scholar]

O’Brien M. Structure and metabolism of tendons. Scand J Med Sci Sports. 1997; 7: 55–61. [PubMed] [Google Scholar]

Hess GP, Cappiello WL, Poole RM, Hunter SC. Prevention and treatment of overuse tendon injuries. Sports Med. 1989;8:371–84. [PubMed] [Google Scholar]

Tipton CM, Matthes RD, Maynard JA, Carey RA. The influence of physical activity on ligaments and tendons. Med Sci Sports. 1975; 7: 165–75. [PubMed] [Google Scholar]

Jozsa LG, Kannus P. Spontaneous rupture of tendons. In: Jozsa LG, Kannus P, editors. Human tendons: anatomy, physiology, and pathology. Champaign, IL: Human Kinetics; 1997. pp. 254–325. [Google Scholar]

Movin T, Kristoffersen WM, Shalabi A, Gad A, Aspelin P, Rolf C. Intratendinous alterations as imaged by ultrasound and contrast medium-enhanced magnetic resonance in chronic achillodynia. Foot Ankle Int. 1998;19:311–7. [PubMed] [Google Scholar]

M Griffin,1 S Hindocha,*,2,3 D Jordan,3 M Saleh,4 and W Khan5. An Overview of the Management of Flexor Tendon Injuries. Open Orthop J. 2012;Suppl 1; 6: 28–35.

Moutiet F. Flexor tendon pulley system: anatomy, pathology, treatment. Chir Main. 2003;22(1):1–12. [PubMed] [Google Scholar]

Green DP, Pederson WC, Hotchkiss RN, Wolfe SW, editors. Greens operative Hand Surgery. 5th. Philadelphia, Pennsylvania: Elsevier Churchill; 2005. [Google Scholar]

Ѓорѓе Џокиќ и сор. Заболувања и повреди на шака, Арсламина. Скопје , 2010.

Tillman LJ, Chasan NP. Properties of dense connective tissue and wound healing. In: Hertling D, Kessler RM, editors. Management of common musculoskeletal disorders: physical therapy principles and methods. 3rd. Philadelphia: Lippincott; 1996. pp. 8–21. [Google Scholar]

Ting J. Tendon injuries across the world. Injury. 2006; 37:1036–42. [PubMed] [Google Scholar]

Kleinert HE, Spokevicius S, Papas NH. History of flexor tendon repair. J Hand Surg Am. 1995; 20: S46–52. [PubMed] [Google Scholar]

Bruner JM. The zig-zag volar-digital incision for flexortendon surgery. Plast Reconstr Surg. 1967;40:571. [PubMed] [Google Scholar]

Hall RF, Jr, Vliegenthart DH. A modified midlateral incision for volar approach to the digit. J Hand Surg Br. 1986;11(2):195–7. [PubMed] [Google Scholar]

Strickland JW. Flexor tendon injuries: I. Foundations of treatment. J Am Acad Orthop Surg. 1995; 3:44–54. [PubMed] [Google Scholar]

Barrie KA, Tomak SL, Cholewicki J, Wolfe SW. The role of multiple strands and locking sutures on gap formation of flexor tendon repairs during cyclical loading. J Hand Surg Am. 2000; 25:714–20. [PubMed] [Google Scholar]

Hatanaka H, Manske PR. Effect of suture size on locking and grasping flexor tendon repair techniques. Clin Orthop Relat Res. 2000; 375:267–74. [PubMed] [Google Scholar]

Manske PR, Lesker PA. Flexor tendon nutrition. Hand Clinics. 1985; 1:13–24. [PubMed] [Google Scholar]

Savage R, Risitano G. Flexor tendon repair using the six-strand method of repair and early active mobilisation. J Hand Surg British. 1989; 14:369–99. [PubMed] [Google Scholar]

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