Staged flexor tendon reconstruction in children

The medical records of 12 children, aged 1 to 15 (mean 8.4 years) who had a total of 14 staged flexor tendon reconstructions for zone 2 flexor tendon injuries between the years of 1974 and 1989 were reviewed. One patient with one treated finger was lost to follow-up one month after Stage II surgery. The rest were followed either to failure or for a minimum of six months after Stage II surgery (range 6 to 108 months ; mean 45 months). Results were graded by the percentage of total passive motion after Stage I converted to active motion after Stage II, and the final total active motion (TAM). Overall, there were seven poor, one fair, two good, and three excellent results. Mean final TAM was 140 degrees (range 90-210 degrees). Results were better in those children whose rehabilitation was supervised by a trained hand therapist (three excellent, one good, and one poor result). Complication included four infections after Stage I, and one infection and one rupture after Stage II. After treatment, these complications resulted in four poor results. Staged flexor tendon reconstruction in children in this series had a higher risk of complications and failure than the same procedure in adults reported in a previous series from this institution. Results in children may be improved by close attention to postoperative care and by patient selection based on ability to cooperate with the postoperative program.