flexor tendon injuries

1. Dr. Utsav Agrawal

2. Anatomy

4. Camper’s
Chiasma
FDS
FDP

7. Examination
 1. Fractures or dislocation
 2. neurovascular injuries
 3. Examination of tendon injuries

9. Investigations
 Clinical examination
 Radiography
 MRI

10. Timing of surgery
 primary –within 24 hrs
 Delayed primary -1 to 10 days
 Secondary – upto 4 wks
 Late secondary beyond 4 wks
 If wound is clean, primary repair, along with care of
neurovascular injury and fracture.

11. EXPOSURES

12.  Core sutures
 Epitenon sutures – reduce bulk and increase strength
 Core sutures –
- careful handling and alignment of tendons
- more dorsal suture placement  better outcome
- More sutures crossing the interaction site, more strength
- lacerations involving more than 60 % cross-section of the
tendon should be repaired
- 4-0 braided sutures like capromid, polyester
Suture Configurations

13. Bunnel Stitch
Kessler Stitch

14. Masson-Allen Criss-cross
Modified kessler Tajima

15. Epitenon suture

16. Tendon to bone attachment

20. Leddy and Packer classification of
FDP avulsion

21.  Leddy type I to be managed as early as possible, atleast
within 3 wks
 II and III can be managed upto 6 wks
 If less than 1 cm distal stump available then FDP
advancement with tendon to bone attachment
 in old and leddy I, keep instruments for tendon
retrieval like infant feeding tube, paediatric sounds
and tendon grafts.
 Retrieval technique – sourmelis-mcgrouther

22. Grafts

24. Post-operative immobilisation

25. Complications
 Adhesion formation
 Implant failure
 Graft failure
 Pulley disruption
 Quadrigia
 Lumbrical plus finger
 Synovitis
 Infection
 Flexion deformity