Flexor tendon injuries of hand
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Transcript of Flexor tendon injuries of hand
FLEXOR FLEXOR TENDON TENDON
INJURIES OF INJURIES OF HANDHAND
Nutrition and repairNutrition and repair
1. synovial fluid in the sheath1. synovial fluid in the sheath 2. vincular circulation2. vincular circulation
vincula longa and brevia each for vincula longa and brevia each for profundus and superficialisprofundus and superficialis
Repair-Repair-
Intrinsic mechanismIntrinsic mechanism
Extrinsic mechanismExtrinsic mechanism
ExaminationExamination
Position and attitude of the hand-Position and attitude of the hand- Unnatural position of hyper Unnatural position of hyper
extension of the finger suggests extension of the finger suggests injury to both tendonsinjury to both tendons
Passive examination-Passive examination- extension of wristextension of wrist flexion of the wristflexion of the wrist Compression of forearm musclesCompression of forearm muscles Pressure on the fingertipsPressure on the fingertips
FDP and FDSFDP and FDS
ZONES OF THE HANDZONES OF THE HAND
ZONESZONES ZONE 1- distal to the insertion of ZONE 1- distal to the insertion of
superficialissuperficialis ZONE 2- no mans land b/w the distal palmar ZONE 2- no mans land b/w the distal palmar
crease and insertion of the sublimiscrease and insertion of the sublimis ZONE 3- lumbrical region b/w distal palmar ZONE 3- lumbrical region b/w distal palmar
crease and the distal end of transverse crease and the distal end of transverse carpal ligamentcarpal ligament
ZONE 4- zone covered by the flexor ZONE 4- zone covered by the flexor retinaculumretinaculum
ZONE 5- proximal to the flexor retinaculumZONE 5- proximal to the flexor retinaculum
RULES OF REPAIRRULES OF REPAIR
All flexor tendons when severed should be repaired All flexor tendons when severed should be repaired irrespective of whatever is the zone.irrespective of whatever is the zone.
Ideally fix the fracture and repair the tendon and Ideally fix the fracture and repair the tendon and digital primarily.digital primarily.
When delayed repair is done may need a tendon When delayed repair is done may need a tendon graftgraft
Flexor tendon sheath should be repaired over the Flexor tendon sheath should be repaired over the tendontendon
A2 and A4 pulleys of the flexor sheaths should be A2 and A4 pulleys of the flexor sheaths should be preserved to prevent bowstringing and flexon preserved to prevent bowstringing and flexon deformitydeformity
PULLEYS OF THE FLX PULLEYS OF THE FLX SHEATHSHEATH
ZONE 1ZONE 1
Repair primarilyRepair primarily To distal stump or advance 1 cmTo distal stump or advance 1 cm More than 1 cm quadriga effect.More than 1 cm quadriga effect. Type 1: 7-10 days retracted in the palm. Type 1: 7-10 days retracted in the palm.
Repair with a pull out wire technique.Repair with a pull out wire technique. Type 2: few months retracted till PIPType 2: few months retracted till PIP Type 3: retracted upto DIP.Type 3: retracted upto DIP. Old cases: tendon grafting, arthrodesis, Old cases: tendon grafting, arthrodesis,
tenodesis tenodesis
Pull out wire techniquePull out wire technique
ZONE 2 ZONE 2
Called bunnells zone or no mans land Called bunnells zone or no mans land zone.zone.
Notorious for bad results, adhesions Notorious for bad results, adhesions are a big problem. Area of pulleysare a big problem. Area of pulleys
Repair both tendons at the same timeRepair both tendons at the same time Tendons are sutured malrotatedTendons are sutured malrotated Suturing should be intratendonous Suturing should be intratendonous
configuration.configuration.
ZONE 3ZONE 3
Lumbrical zoneLumbrical zone Primarily suturedPrimarily sutured Do not suture the belly of the Do not suture the belly of the
lumbricals as it increases the tension lumbricals as it increases the tension of the musclesof the muscles
Lumbrical plus syndrome- Lumbrical plus syndrome- paradoxical extension on attempted paradoxical extension on attempted flexionflexion