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Tendon flexor injury

FDS (flexor digitorum superfisialis)


origin (2 muscle belly)
Epicondilus Medial Radial shaft

FDP (flexor digitorum profundus)


Origin: ulna & membran interosseous FDP: Common muscle origin for several tendons

FDP

FDS FDP FPL Lumbricals origin from radial side of FDP

CAMPERs CHIASMA
FDS divides and passes around the FDP tendon, the two portions of the FDS reunite at Campers Chiasma

PULLEYS

Preserve A2 and A4 pulley to prevent bowstringing. NOTE: There is a mistake in this diagram: The C1 pulley is DISTAL to the A2 pulley!

BLOOD SUPPLY
Segmental branches of digital arteries which enter the tendon through:
vincula osseous insertions

Synovial fluid diffusion

FDS: Clinical Exam

FDS: Clinical Exam

FDP: Clinical Exam

ZONES

COMPLICATIONS
Stiffness Re-rupture Tenolysis may be required in an estimated 18% to 25% of patients
No earlier than 3 months after repair If no ROM improvement for 1-2 months

TENDON HEALING

PHASES OF TENDON HEALING


1.Inflamasi (0-5 ) : 2.Fibroblastic (5-28 ) : collagen-producing phase 3.Remodelling (28 hari - 4 bulan)

SUTURE TECHNIQUES

Kessler

Modified Kessler
(1 suture)

Advantage: Only one node inside the repair site. Easier to use a monofilament suture like a 4.0 Proline to re-approximate tendon edges.

Kessler-Tajima
(2 sutures)

SUTURE MATERIAL
Non-absorbable Most authors prefer a synthetic braided 3.0 or 4.0 suture, usually of polyester material (Mersilene, Tycron, Tevdek) However, monofilament sutures like nylon and wire are also used (e.g. Proline) Additional running, circumferential 5-0 or 6-0 nylon is used often

POST-OP PROTOCOLS
1. Kleinert: Active extension, passive flexion by rubber bands 2. Duran: Controlled Passive Motion Methods 3. Strickland: Early active ROM

GOAL: FULL ACTIVE ROM @ 10-12 weeks

Kleinert Protocol

COMPLICATIONS
Joint contracture Adhesions Rupture Bowstringing Infection