Results of flexor tendon surgery in zone II.

In this article we have attempted to analyze the results of Zone II flexor tendon repair, staged flexor tendon reconstruction, and tenolysis based on cases taken from a single hand surgical practice. Formulas have been offered to determine the percentage return of motion at the PIP and DIP joints utilizing the total active and passive motion measurements. Variation in the formulas for each procedure are necessitated by the preoperative active and passive motion. A common classification system based on the percentage return following each procedure has also been utilized. By employing these assessment methods on digits of our patients who underwent flexor tendon repairs, we achieved the following results: Digits undergoing primary flexor tendon repair in Zone II with postoperative controlled passive motion techniques returned 56 per cent excellent or good function, with 13 per cent in the poor category and 4 per cent experiencing tendon rupture. Staged flexor tendon reconstruction returned 40 per cent excellent or good results with 66 per cent categorized as excellent, good, or fair. Twenty-eight per cent remained in the poor classification, with 7 per cent having ruptures. These results were substantially upgraded by tenolysis of the tendon grafts following Stage II in 47 per cent of all digits. Tenolysis was an effective procedure following a repair or graft and was found to return 67 per cent excellent or good results when carried out for adherent tendon repairs, with 10 per cent in the poor category and an 8 per cent rupture rate. A 65 per cent excellent or good return followed tenolysis of flexor tendon grafts, with 12 per cent judged poor and 8 per cent incidence of rupture. An analysis of the theoretical results of 100 consecutive Zone II flexor tendon repairs following multiple procedures for those digits that had unsatisfactory initial results indicated that, under ideal circumstances, as high as 96 per cent of all digits might be expected to return flexor performance in the excellent or good categories. I acknowledge that the results of flexor tendon procedures are strongly influenced by a wide array of factors, including the patient's age and motivation, the preoperative status of the digit, surgical technique, and postoperative management. An effort has been made here to minimize the variables by including patients taken from a single hand surgical practice and managed, to a large extent, by the same surgeon.(ABSTRACT TRUNCATED AT 400 WORDS)