Pediatric Flexor Tendon Repair Outcomes: A Systematic Review and Meta-analysis
Aneesh Karir, BHSc; Minh NQ Huynh, BSc
University of Ottawa, Ottawa, ON, Canada
The evidence in the literature remains scarce for pediatric outcomes after flexor tendon repairs. Currently, there is no published systematic review on pediatric flexor tendon repairs. The purpose of this study was to review the approach and outcomes of pediatric flexor tendon repairs within the literature.
Materials & Methods
A literature search was performed using PubMed (1966 to June 2018); Ovid MEDLINE (1966 to June 2018); EMBASE (1988 to June 2018); and Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, to June 2018) databases by two reviewers in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance . We included all full text articles which included patients 18 years or younger with flexor tendon injuries that were primarily repaired. Articles were excluded if they included patients over 18 years of age, if tendon grafts were used, if repair was done in more than one stage, if it was not a primary research article, or if the language of publication was not English. We collected data on patient demographics, injury characteristics, repair technique, rehabilitation protocol used, TAM scores, and complications.
The literature search generated 596 unique articles. In total, 180 articles were included for full text screening. We identified 17 articles that met our inclusion criteria. In total, there were 531 patients with 618 injured digits. The distribution of injured tendons in zones I, II, III, IV, and V were 55, 485, 21, 2, and 49, respectively. The number of injured FDP, FDS, and FPL tendons were 433, 48, and 156, respectively. The most common mechanism of injury was a laceration from glass. Immobilization was used for rehabilitation in 124 patients, while early active movement was used in 226 patients. The most common repair technique was the modified Kessler (n= 372 digits). There were 148 digits with concurrent digital nerve injuries. Time to repair ranged from within 12 hours to within 1 year post-injury. The TAM functional assessment was excellent in 341 fingers, good in 74 fingers, fair in 56 fingers, and poor in 28 fingers. In total, there were 8 tendon ruptures and 2 patients with wound infections. The mean follow-up time ranged from 2.7 months to 8 years. There were no factors that were associated with outcomes.
Pediatric tendon injuries have a low incidence of ruptures and infections. Flexor tendon repairs have highly successful functional outcomes without any predictive factors.
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