Alaa A Dawood1. 1. F.I.C.M.S. (Ortho.), Consultant Orthopedic Surgeon, Assistant Professor Orthopaedic Surgeon, Basrah College of Medicine, Basrah, Iraq.
Abstract
BACKGROUND: Flexor tendon injuries are commonly encountered and the surgical repair still represents a challenging problem. Many repair techniques are present but there is still no ideal one that achieves the best functional outcome. This study was undertaken to compare four-strand locked cruciate repair technique and modified Kessler technique in forty eight patients by assessing the functional outcome. METHODS: Forty eight patients (114 digits) with flexor tendon injury were assigned into two groups based on suture repair technique; Group A: 24 cases by Modified Kessler repair (50%). Group B: 24cases by 4-strand cruciate repair (50%). Adults in Both groups were rehabilitated by combined Duran protocol and early active mobilization while no specific rehabilitation program was used for pediatric age group. Follow up was from 6 to 36 months (mean 21.5). Functional outcome was assessed by White criteria to all patients after 6 months. RESULTS: Functional outcome was better in 4 strand cruciate repair with excellent result in 66.6%, good in 29.1% and fair in 4.1%, as compared to modified Kessler technique in which excellent results were found in 45.8%, good in 37.5%, fair in 12.5% and poor in 4.1% of cases. A better functional result was achieved in 4 strand cruciate repair especially in zone II, with excellent results in 33.3%, good in 50% and fair in 16.6% of cases, as compared to modified Kessler repair with no excellent results, 33.3% good, 50% fair and 16.6% poor results. In zone III, 4 strand cruciate technique showed a better functional outcome with 77.7% excellent and 22.2% good results, as compared to 55.5% excellent and 44.4% good results found in Modified Kessler repair. Zone V showed almost comparable results between the two types of repairs. CONCLUSION: The 4-strand cruciate repair technique had better functional outcome compared to modified Kessler repair technique, especially in zone II and III.
BACKGROUND: Flexor tendon injuries are commonly encountered and the surgical repair still represents a challenging problem. Many repair techniques are present but there is still no ideal one that achieves the best functional outcome. This study was undertaken to compare four-strand locked cruciate repair technique and modified Kessler technique in forty eight patients by assessing the functional outcome. METHODS: Forty eight patients (114 digits) with flexor tendon injury were assigned into two groups based on suture repair technique; Group A: 24 cases by Modified Kessler repair (50%). Group B: 24cases by 4-strand cruciate repair (50%). Adults in Both groups were rehabilitated by combined Duran protocol and early active mobilization while no specific rehabilitation program was used for pediatric age group. Follow up was from 6 to 36 months (mean 21.5). Functional outcome was assessed by White criteria to all patients after 6 months. RESULTS: Functional outcome was better in 4 strand cruciate repair with excellent result in 66.6%, good in 29.1% and fair in 4.1%, as compared to modified Kessler technique in which excellent results were found in 45.8%, good in 37.5%, fair in 12.5% and poor in 4.1% of cases. A better functional result was achieved in 4 strand cruciate repair especially in zone II, with excellent results in 33.3%, good in 50% and fair in 16.6% of cases, as compared to modified Kessler repair with no excellent results, 33.3% good, 50% fair and 16.6% poor results. In zone III, 4 strand cruciate technique showed a better functional outcome with 77.7% excellent and 22.2% good results, as compared to 55.5% excellent and 44.4% good results found in Modified Kessler repair. Zone V showed almost comparable results between the two types of repairs. CONCLUSION: The 4-strand cruciate repair technique had better functional outcome compared to modified Kessler repair technique, especially in zone II and III.
Authors: Mordechai Vigler; Ram Palti; Rachel Goldstein; Vipul P Patel; Phillip Nasser; Steve K Lee Journal: J Hand Surg Am Date: 2008-12 Impact factor: 2.230