RESULTS OF SURGERY OF CHRONIC FINGER FLEXOR TENDONS INJURIES IN FIBRO-OSSEOUS CANALS

Background. Restoration of finger flexor tendons in fibro-osseous canals in the long term after injury is a difficult task due to scarring blockage and the impossibility of early active rehabilitation. Therefore, it is important to develop methods for durable tendon reconstruction that can provide early rehabilitation of patients without the risk of rupture of the suture zone. Aim. To evaluate the clinical effectiveness of surgeries on the flexor tendons of fingers in case of chronic injuries in fibro-osseous canals with the creation of strong connections in the sutured zone. Material and methods. The study included 66 patients with chronic injuries of 104 flexor tendons in fibro-osseous canals of the fingers. The main group consisted of 29 patients who underwent restoration of 47 tendons using new methods within 3 to 11 weeks after injury: subgroup A included 23 cases of reconstruction of the deep flexor tendon with a hidden transosseous suture in zone I; subgroup B included 24 sutures with isolation with dissected polymeric tube in zone II. Control group included 37 patients with tendon injuries on 49 fingers within fibro-osseous canals with injury term from 3 weeks to 30 years who underwent classical surgeries: secondary flexor digitorum profundus suture on 31 fingers, 2-stage tendoplasty – on 13, distal phalanx tenodesis – on 4 and reinsertion by Bunnell – on 1 finger. Also, as a control, 8 fingers were evaluated in 7 patients of the main group on which 4 secondary sutures, 2 tendoplasties and 2 tenodeses were performed. Finger function was determined by J.W. Strickland before 3, 6 months and 1 year after surgery, qualitative parameters were analyzed using two-tailed Fisher's exact test. Hand function was evaluated using the DASH questionnaire before surgery and 1 year later, the significance of differences was checked using the Mann-Whitney U-test. Results. The use of durable tendon reconstruction methods in patients of the main group enables to obtain results on average in 3 months similar to the results of 2-stage tendoplasty 10-12 months after the start of treatment in the control group. The results of reinsertion with a hidden transosseous suture and suture with temporary isolation with dissected polymer tubes did not differ significantly in terms of the degree of range of motion recovery and hand function assessment by patients. Conclusions. The developed methods showed better results in restoring the function of the fingers in comparison with classical surgeries. A strong tendon connection combined with an early start of movement increases the number of good and excellent functional outcomes and ensures patients' satisfaction with treatment results.