Extensor Tendon Injuries in Children

Author(s): Fitoussi F, Badina A, Ilhareborde B, Morel E, Ear R, Pennecot GF

Source: J Pediatr Orthop 27:863-866, 2007.

Summary:

The authors attempted to analyze the factors that lead to good or bad outcome following extensor tendons injuries.  Eighty-three children were initially included but for various reasons the ultimate cohort ended up with 50 patients with 53 injured digits.  The medial age was approximately 9 years.  The children were divided into various categories including age, severity of lacerations and repair techniques.  A variety of techniques and suture materials were utilized.  Immobilization averaged approximately  4 weeks.  Follow-up range of motion was measured by adding the MP, PIP and DIP joints and subtracting the extension lags.

The lacerations involved 11 thumbs and 42 fingers.  A variety of mechanisms resulted in lacerations.  The Verdan classification was used related to the zone of injury.  Zones I, II, and III produced a higher percentage of extensor lags than did more proximal injuries.  Zones IV and VI faired better than Zones I, II and III.  There was some statistical significance related to age.  Children younger than 5 years ended up with a higher percentage of extension lags.  All fingers with incomplete lacerations had a good or excellent results related to outcome.  Only 1 patient sustained a postoperative infection .

The results of this study showed that primary repair after extensor tendon laceration in children leads to excellent or goods results in roughly than 90-95% of cases.  Interestingly, injuries combined with joint capsule damage did not adversely affect outcome in this publication.  As expected, incomplete tendon injury had a final outcome that was better than complete lacerations.  Most importantly, transactions of tendons in zones I, II and III led to the highest percentage of fair or poor results with development of an extension lag.  This information should be communicated to parents at the time of injury.  The authors hypothesize that the use of Kirschner wires may lessen the chances of extension lag and this should be considered at the time of surgery.

Extensor, Tendon, Laceration, Repair, Function, Children


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