Embedded Files
Introduction
Introduction
- Traumatic injury to the flexor tendon (1)
- Classified by the Verdan's Flexor Zones (See below)
- Described as the injury position when the fingers and thumb are extended and not the initial surface laceration.
- Classified by the Verdan's Flexor Zones (See below)
- Mechanism of injury
- Commonly results from volar lacerations and subsequent neurovascular injury
- Closed avulsions of the FDP usually occur during contact sports ("Rugby Jersey Finger")
- Anatomy (may help with assessment)
- There are several flexor tendons in the hand
- Flexor digitorium profundus (FDP)
- Location: inserts at the base of distal phalanx of digits 2-5
- Action: flexor of the DIPJ, assists with PIP and MCP flexion
- Innervation: anterior interosseous n. (index + long fingers) and ulnar n. (ring and short fingers)
- Flexor digitorium superficialis (FDS)
- Location: inserts at the bodies of middle phalanges of fingers
- Action: PIPJ flexor, assists with MCP flexion
- Innervation: median n.
- Flexor pollicis longus (FPL)
- Location: within carpal tunnel (most radial structure)
- Action: thumb phalanx flexor, assists with wrist flexion
- Innervation: anterior interosseous n. (median n. branch)
- Flexor carpi radialis (FCR)
- Location: inserts on base of second MCP. Closest flexor tendon to median n.
- Action: wrist flexor
- Innervation: median n.
- Flexor carpi ulnaris (FCU)
- Location: inserts on pisiform, hook of hamate and base of 5thMCP.
- Action: wrist flexor
- Innervation: ulnar n.
- Flexor digitorium profundus (FDP)
- There are several flexor tendons in the hand
assessment (2)
assessment (2)
- The laceration may cut the tendon in flexion or extension making it not visible
- Assess neurovascular status as well as passive and active joint flexion in isolation
- Noting the Verdan Flexor zone is useful when describing injury over the phone/trauma meeting
- XR Hand:
- AP, lateral, oblique
management (3,4)
management (3,4)
- Remove jewellery and keep patient NBM
- Check tetanus status
- Pain relief and if open injury consider antibiotics (consult local antimicrobial guidelines)
- Wounds requiring further exploration in theatre and/or tendon repair should be washed out with copious saline or tap water irrigation
- Close the wound and dress appropriately (non-adherent dressing first e.g. atrauman).
- Place in a splint in Edinburgh position
- Elevate and discuss with a senior
- Likely will need a tendon repair under anaesthesia (GA or wrist block).
- Rehab will involve early motion to progress to full active flexion.
references
references
1. Chiu TW. Stone’s Plastic Surgery Facts: A Revision Guide, Fourth Edition. CRC Press; 2018. 2. Green DP, Wolfe SW. Green’s operative hand surgery. Elsevier/Churchill Livingstone; 2011. 3. Griffin M, Hindocha S, Jordan D, Saleh M, Khan W. An overview of the management of flexor tendon injuries. Open Orthop J. 2012;6:28–35. 4. The British Society of Surgery for the Hand. Hand Injury Triage App [Internet]. [cited 2020 Feb 2]. Available from: handinjurytriageapp.bssh.ac.uk
Image References:Header: Licensed with Adobe Stock 2019Verdan's Zones - Made by Viktorija Kaminskaite
Image References:Header: Licensed with Adobe Stock 2019Verdan's Zones - Made by Viktorija Kaminskaite
This page has been reviewed by:
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (09/02/2020)
1) Mr. Martin Shapev - Plastic Surgery Registrar, RD&E (09/02/2020)
Page updated
Google Sites
Report abuse