Two-stage tendoplasty of the flexor digitorum profundus in a small child

Abstract

BACKGROUND: Injuries to the flexor tendons of the fingers are uncommon in young children, and chronic injury is an extremely rare injury. Many issues of damage diagnosis, surgical intervention and rehabilitation techniques remain unresolved. In this regard, the treatment of chronic damage to the flexor tendons of the fingers in young children has practical and theoretical significances.

CLINICAL CASE: A 16-month old underwent a two-stage treatment of chronic damage to the flexor tendons of the small finger. At the first stage, scars were removed from the fibro-synovial canal, and a silicone rod was inserted into the canal. At the second stage, the silicone spacer was replaced by a tendon autograft. The surgical treatment and postoperative management of the patient was described in detail. The full range (270 degrees) of active and passive motion was restored five months after the second stage of tendoplasty. Two years after the operation, good hand function.

DISCUSSION: The analyzed publications mainly present the results of treatment of patients older than 1 year and 4 months. Only in the study by S.L. Piper et al. (2019) the youngest patient at the time of injury was 7 months old, at the time of first stage of tendoplasty – 1 year and 3 months. The final volume of active motion was 160 degrees. In our case, the functional result was higher. Considering the undoubted rarity of damage uncharacteristic for this age, we intend to continue monitoring the patient.

CONCLUSIONS: Comprehensive long-term treatment of a serious injury to the hand, considering the anatomical and physiological characteristics of a small child, made it possible to obtain a good functional result.

Keywords

finger flexor tendon / chronic damage / two-stage plastic / children / clinical case

References

[1] Piper SL, Wheeler LC, Mills JK, et al. Outcomes after primary repair and staged reconstruction of zone I and II flexor tendon injuries in children. J Pediatr Orthop. 2019;39(5):263−267. DOI: 10.1097/BPO.0000000000000912

[2] Piper S.L., Wheeler L.C., Mills J.K. et al. Outcomes after primary repair and staged reconstruction of zone I and II flexor tendon injuries in children // J. Pediatr. Orthop. 2019. Vol. 39. No. 5. P. 263−267. DOI: 10.1097/BPO.0000000000000912

[3] Alexandrov AV, Rybchenok VV, Lvov NV, et al. Two-stage tendon plasty of the flexor tendons of the fingers in children with chronic injuries in the area of fibro-synovial canals. Bulletin of RSMU. 2016;(5):29−33. (In Russ.)

[4] Александров А.В., Рыбченок В.В. Львов Н.В. и др. Двухэтапная тендопластика сухожилий сгибателей пальцев кисти у детей с застарелыми повреждениями в зоне фиброзно-синовиальных каналов // Вестник РГМУ. 2016. № 5. С. 29−33.

[5] Courvoisier A, Pradel P, Dautel G. Surgical results of one-stage and two-stage flexor tendon repair in children. J Pediatr Orthop. 2009;29(7):792−796. DOI: 10.1097/BPO.0b013e3181b76a16

[6] Courvoisier A., Pradel P., Dautel G. Surgical outcome of one-stage and two-stage flexor tendon grafting in children // J. Pediatr. Orthop. 2009. Vol. 29. No. 7. P. 792−796. DOI: 10.1097/BPO.0b013e3181b76a16

[7] Volkova AM. Hand surgery. Yekaterinburg: Middle Ural book publishing house; 1991. Vol. 1. (In Russ.)

[8] Волкова А.М. Хирургия кисти. Екатеринбург: Средне-Уральское книжное издательство, 1991. Т. 1.

[9] Jong LP, Nguyn JT, Sonnema AM, et al. The incidence of acute traumatic tendon injuries in the hand and wrist: a 10-year population-based study. Clinics in Orthopedic Surgery. 2014;6(2):196−202.

[10] Jong L.P., Nguyn J.T., Sonnema A.M. et al. The incidence of acute traumatic tendon injuries in the hand and wrist: a 10-year population-based study // Clinics in Orthopedic Surgery. 2014. Vol. 6. No. 2. P. 196−202.

[11] Neutosvaara Y, Lindfors NC, Palmu S, et al. Flexor tendon injuries in pediatric patients. J Hand Surg. 2007;32A:1549−1557.

[12] Neutosvaara Y., Lindfors N.C., Palmu S. et al. Flexor tendon injuries in pediatric patients // J. Hand Surg. 2007. Vol. 32A. P. 1549−1557.

[13] Tang JB. Flexor tendon injuries. Clin Plastic Surg. 2019;46:295–306. DOI: 10.1016/j.cps.2019.02.003

[14] Tang J.B. Flexor tendon injuries // Clin. Plastic. Surg. 2019. Vol. 46. P. 295–306. DOI: 10.1016/j.cps.2019.02.003

[15] Al-Qattan MM. Flexor tendon injuries in the child. J Hand Surg Eur Vol. 2014;39(1):46−53. DOI: 10.1177/1753193413498207

[16] Al-Qattan M.M. Flexor tendon injuries in the child // J. Hand Surg. Eur. Vol. 2014. Vol. 39. No. 1. P. 46−53. DOI: 10.1177/1753193413498207

[17] Klyukvin IYu, Miguleva IYu, Okhotsky VP. Hand injury. Moscow: GOETAR-Media; 2009. P. 29−77. (In Russ.)

[18] Клюквин И.Ю., Мигулева И.Ю., Охотский В.П. Травмы кисти. М.: ГОЭТАР-Медиа, 2009. С. 29−77.

[19] Fitoussi F, Mazda K, Frajman J-M, et al. Repair of the flexor pollicis longus tendon in children. Journal of Bone and Joint Surgery. 2000;82B(8):1177−1180.

[20] Fitoussi F., Mazda K., Frajman J.-M. et al. Repair of the flexor pollicis longus tendon in children // J. Bone Joint Surg. 2000. Vol. 82B. No. 8. P. 1177−1180.

RIGHTS & PERMISSIONS

Zolotov A.S., Mbeki J.A.