A mini-invasive tenolysis of the flexor tendons following hand fractures: case series

Abstract

Introduction

The treatment of the flexor tendon adhesions following phalanx and metacarpal fractures, in closed or open injuries, is a great challenge for the hand surgeon. The outcomes are often poor, because of the severity of the lesion and the aggressiveness of the surgical procedure of the secondary tenolysis.

Materials and methods

The authors describe the technical findings and the results of a new mini-invasive tenolysis in order to treat the adhesions in zone 1 and 2 of the fingers, following phalangeal and metacarpal fractures. With an atraumatic Allis or Duval surgical forceps, the flexor tendons are separately and gently tracted making a twisting movement on themselves until the adhesions were torn and the tendons appeared released.

Results

The relevant outcomes achieved show this technique is very useful to treat tendon adhesions, without adding trauma and scare to the tendinous canal and surrounding soft tissues.

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References

  1. 1.

    Brooks DM (1970) Problems of restoration of tendon movements after repair and grafts. Proc R Soc Med 63:67

    CAS  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Brunelli GA (2001) La tenolisi. In: Brunelli GA (ed) La Mano. Ed. Micom, Milano

    Google Scholar 

  3. 3.

    Bunnel S (1918) Repair of tendons in fingers and description of two new instruments. Surg Gynecol Obstet 26:103–110

    Google Scholar 

  4. 4.

    Comtet JJ (1999) La ténolyse des fléchisseurs: rappel des méthodes chirurgicale. La Main 4:47–49

    Google Scholar 

  5. 5.

    Fetrow KO (1967) Tenolysis in the hand and wrist: a clinical evaluation of two hundred and twenty flexor and extensor tenolysis. J Bone Joint Surg 49A:667–685

    Article  Google Scholar 

  6. 6.

    Goloborod’ko SA (2000) Postoperative management of flexor tenolysis. J Hand Ther 12:330–332

    Article  Google Scholar 

  7. 7.

    Giustini M, De Leo A, Leti Acciaro A, Pajardi G et al (2015) Incidence estimates of hand and upper extremity injuries in Italy. Ann Ist Super Sanita 51(4):305312

    Google Scholar 

  8. 8.

    Hunter JM, Salisbury RE (1971) Flexor tendon reconstruction in severely damaged hands: a two-stage procedure using a silicone-dacron reinforced gliding prosthesis prior to tendon grafting. J Bone Joint Surg 53:829–858

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Karl JW, Olson PR, Rosenwasser MP (2015) The epidemiology of upper extremity fractures in United Sates, 2009. J Orthop Trauma 29(8):e242–e244

    Article  PubMed  Google Scholar 

  10. 10.

    Kirchhoff R, Jensen PB, Nielsen NS, Boeckstyns ME (2000) Repeated digital nerve block for pain control after tenolysis. Scand J Plast Reconstr Surg Hand Surg 34:257–258

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Kobayashi M, Toguchida J, Oka M (2001) Development of polyvinyl alcohol-hydrogel (PVA-H) shields with a high water content for tendon injury repair. J Hand Surg 26B:436–440

    Article  Google Scholar 

  12. 12.

    Landi A, Cavana R, Caserta G et al (1994) Il punto sulla tenolisi dei tendini flessori nella zona 2. GIOT 20:347–358

    Google Scholar 

  13. 13.

    Leti Acciaro A, Russomando A, Caserta G, Landi A (2007) La tenoartrolisi totale anteriore nel trattamento della rigidità in flessione delle dita. Riv Chir Mano 44(2):69–77

    Google Scholar 

  14. 14.

    Leti Acciaro A, Chiarelli N, Lando M, Russomando A, Landi A (2015) La Tenolisi mini-invasiva dei tendini flessori negli esiti delle fratture alle dta della mano, Preliminary Report. Riv Chir Mano 52(2):11–19

    Google Scholar 

  15. 15.

    Liew SH, Potokar T, Bantik GL et al (2001) The use of Adcon-T/N after repair of zone II flexor tendons. Chir Main 20:384–387

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Luppino T, Fiocchi R, Salsi A et al (1988) La nostra esperienza nelle tenolisi dei flessori della mano. Riv Chir Mano 25:79–85

    Google Scholar 

  17. 17.

    Mentzel M, Hoss H, Keppler P et al (2000) The effectiveness of Adcon-T/N, a new anti-adhesion barrier gel, in fresh divisions of the flexor tendons in zone II. J Hand Surg 25B(6):590–592

    Article  Google Scholar 

  18. 18.

    Reuben SS, Steinberg RB, Lurie SD, Gibson CS (1999) A dose-response study of intravenous regional anesthesia with meperidine. Anesth Analg 88:831–835

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Riccio Battiston B, Pajardi G et al (2010) Efficiency of Hyaloglide in the prevention of the recurrence of adhesions after tenolysis of flexor tendons in zone II: a randomized, controlled, multicentre clinical trial. J Hand Surg 35(2):130–138

    Article  Google Scholar 

  20. 20.

    Schneider LH, Hunter JM (1982) Flexor tendons—Late reconstruction. In: Green DP (ed) Operative hand surgery. Churchill Livingstone, New York, pp 1375–1440

    Google Scholar 

  21. 21.

    Schneider LH, Mackin EJ (1978) Tenolysis. In: Hunter JM, Schneider LH, Mackin EJ et al (eds) Rehabilitation of the hand. CV Mosby, St Louis, pp 229–234

    Google Scholar 

  22. 22.

    Stark HH, Boyes JH, Johonson L, Ashworth CR (1977) The use of paratenon, polyethylene film or Silastic sheeting to prevent restricting adhesions to tendons in the hand. J Bone Joint Surg 59A:908–913

    Article  Google Scholar 

  23. 23.

    Strickland JW (2000) Development of flexor tendon surgery: twenty-five years of progress. J Hand Surg 25A:214–233

    Article  Google Scholar 

  24. 24.

    Strickland JW (1989) Flexor tendon surgery. Part 2: free tendon grafts and tenolysis. J Hand Surg 14B:368–382

    Article  Google Scholar 

  25. 25.

    Verdan C (1979) Tenolysis. In: Verdan C (ed) Tendon surgery of the hand. Churchill Livingstone, New York

    Google Scholar 

  26. 26.

    Whitaker JH, Strickland JW, Ellis RK (1977) The role of flexor tenolysis in the palm and digits. J Hand Surg 2:462–470

    CAS  Article  Google Scholar 

  27. 27.

    Yan YM, Zhang WP, Liao Y et al (2011) Analysis and prevention of the complications after treatment of metacarpal and phalangeal fractures with internal fixation. Zhongguo Gu Shang 24(3):199–201

    PubMed  Google Scholar 

  28. 28.

    Yamazaki H, Kato H, Uchiyama S et al (2008) Results of tenolysis for flexor tendon adhesion after phalangeal fracture. J Hand Surg Eur 33(5):557–560

    CAS  Article  Google Scholar 

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Correspondence to A. Leti Acciaro.

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Leti Acciaro, A., Lando, M., Russomando, A. et al. A mini-invasive tenolysis of the flexor tendons following hand fractures: case series. Musculoskelet Surg 102, 41–45 (2018). https://doi.org/10.1007/s12306-017-0493-9

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Keywords

  • Hand fracture
  • Tenolysis
  • Adhesion
  • Complications
  • Mini-invasive