R. Christie Wray

Treatment of partial tendon lacerations.

We treated twenty six patients with thirty four partial tendon lacerations by not suturing the tendons and by early mobilization of the digit. These partial tendon lacerations varied from 25 to 95 per cent of the cross sectional area. The mean and median cross-sectional area lacerated was 60 per cent. Twenty three of these patients obtained excellent function, one patient obtained good to excellent function and one patient obtained fair function. One patient was lost to follow-up. No tendon ruptured but one patient did develop trigger finger which spontaneously resolved. Partial flexor tendon lacerations should not be repaired and early active motion should be used if bevelling of the laceration is not present. Bevelled partial tendon lacerations of less than twenty five per cent of the cross sectional area can be either excised or repaired with a simple interrupted suture. If greater than twenty five per cent of the cross-sectional area is lacerated and bevelled, the laceration should be repaired with a few simple sutures. Regardless of the treatment of the tendon early active motion is necessary.

Rate and extent of functional recovery after flexor tendon grafting with and without silicone rod preparation

Forty-six consecutive patients requiring flexor tendon grafts were evaluated at 4, 6, 8, 10, 12, 16, 20, 22, 24, 28, 34, and 52 weeks after grafting. The patients were divided into two groups: those who did not require a silicone rubber rod prior to tendon grafting (Group I), and those who did require a silicone rubber rod prior to grafting (Group II). Analysis of the rate of functional recovery as measured by total active motion, gross grip strength, and pinch grip strength showed no significant difference between the two groups. Analysis of the extent of functional recovery at one year, as measured by total active motion and distance of digital pulp from distal palmar crease, showed no significant differences between Groups I and II.

Experimental comparison of technics of tendon repair

We compared tendon gliding and tensile strengths after 70 modified Bunnell, Kessler, Kleinert, or Tsuge flexor tendon repairs in chickens. We evaluated gliding by three different measurements: angular motion, longitudinal tendon movement with the toe intact, and with the repair isolated. The tendon dimensions and the rupture strengths were measured. We found equal rupture rates and tensile strengths after all repairs and equal gliding after the modified Bunnell, Kessler and Kleinert repairs. Angular motion was better after the Tsuge repair than after the modified Bunnell repair, but longitudinal tendon movement with the toe intact or with the repair isolated was the same. From our observations we believe that a hand surgeon could use either the Bunnell, Kessler, Kleinert, or Tsuge technic of flexor tendon repair and expect equal results.

Flexible-implant arthroplasty and finger replantation.

We performed flexible-implant arthroplasty in three metacarpophalangeal joints in two patients at the time of finger replantation. We believe flexible-implant arthroplasty is preferable to permanent arthrodesis for most patients.: We performed flexible-implant arthroplasty in three metacarpophalangeal joints in two patients at the time of finger replantation. We believe flexible-implant arthroplasty is preferable to permanent arthrodesis for most patients.