Flexor Tendon Lesions in Children: Diagnosis, Treatment, and Early Active Motion Rehabilitation

Abstract

Flexor tendon injuries in children represent a diagnostic and therapeutic challenge for surgeons. These injuries can go unnoticed and rehabilitation is difficult, but good results are achieved after treatment. In the recent years, with the evolution of repair techniques of flexor tendons, in adult patients, an early active motion regime was introduced. In pediatric age, there is not still common consensus for surgical technique and for postoperative rehabilitation. In children aged between 3 and 7 years, we prefer the pullout technique while in children aged between 8 and 12 years the four-strand suture associated with the peripheral epitendinous suture. Partial early active motion protocol is started no later than 7 days after the repair. Between April and December 2018, four children were treated. There were no complications such as rupture, inflammation, infection, or contractures of the proximal interphalangeal joint at the final follow-up. No patient needs tenolysis. Good and excellent results were registered in all four digits, respectively, with the TAM score and the Strickland method. We do believe that early active motion by promoting tendon gliding immediately avoids the exclusion of the hand and the loss of the motor pattern and favors the return to play activities.