Management of acute flexor tendon injury in the hand.

In this report, we have attempted to review the current state of the art with regard to the treatment of partial flexor tendon injuries, the strength of the flexor tendons and its relationship to complete tendon lacerations, and the importance of passive joint motion to improve tendon excursion. At this time, it appears that most partial flexor tendon injuries are best treated by nonsurgical repair and an early active assisted or passive range-of-motion exercise program for a period of 3 to 4 weeks. Protecting the hand up to a total of 10 to 12 weeks seems reasonable based on studies of tendon strength. Surgical intervention is necessary to prevent complications of triggering, entrapment, or rupture, which generally occur with lacerations of greater than 60%. We would reserve the repair of partial flexor tendon injuries to lacerations where tendon rupture, triggering, or entrapment would be expected. After flexor tendon repair, knowledge of the strength of tendons and the need for passive mobilization are important. There is not sufficient strength within the flexor tendon repair site to allow for active mobilization sooner than 17 days. Probably only with a lateral trap stitch similar to that described by Becker or with extremely well supervised and trusted patients can active motion be started this early. There is insufficient intrinsic tendon strength to consider active motion (without assistance) earlier than 3 1/2 to 4 weeks. Passive range of motion using the Kleinert-Atasoy or Durand technique before this period is important in not only increasing tendon gliding (or excursion) but also being a stimulus to improve flexor tendon healing strength.(ABSTRACT TRUNCATED AT 250 WORDS)