Two-stage tendoplasty of the flexor digitorum profundus in a small child

BACKGROUND: Injuries to the flexor tendons of the fingers are uncommon in young children, and chronic injury is an extremely rare injury. Many issues of damage diagnosis, surgical intervention and rehabilitation techniques remain unresolved. In this regard, the treatment of chronic damage to the flexor tendons of the fingers in young children has practical and theoretical significances.

CLINICAL CASE: A 16-month old underwent a two-stage treatment of chronic damage to the flexor tendons of the small finger. At the first stage, scars were removed from the fibro-synovial canal, and a silicone rod was inserted into the canal. At the second stage, the silicone spacer was replaced by a tendon autograft. The surgical treatment and postoperative management of the patient was described in detail. The full range (270 degrees) of active and passive motion was restored five months after the second stage of tendoplasty. Two years after the operation, good hand function.

DISCUSSION: The analyzed publications mainly present the results of treatment of patients older than 1 year and 4 months. Only in the study by S.L. Piper et al. (2019) the youngest patient at the time of injury was 7 months old, at the time of first stage of tendoplasty – 1 year and 3 months. The final volume of active motion was 160 degrees. In our case, the functional result was higher. Considering the undoubted rarity of damage uncharacteristic for this age, we intend to continue monitoring the patient.

CONCLUSIONS: Comprehensive long-term treatment of a serious injury to the hand, considering the anatomical and physiological characteristics of a small child, made it possible to obtain a good functional result.