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This is a prospective study of flexor tendon repair in 26 children with 35 involved fingers, their age ranged between 1.5 to 15 years (average 7). They were presented for surgery within 3 weeks of the injury. Tendon repair using the 4strand core suture technique was performed in 65% of the hands and 2-strand in 35%, and postoperatively 73% of the patients were immobilized by an above-elbow splint. The average follow up period was 9 months (ranged from 4 to 24). Using the Louisville scoring system, satisfactory results was achieved using 4 strand core suture technique and immobilization by above-elbow splint in 77% of the patients. The postoperative complications consisted of tendon ruptures in 15% of the cases mostly in those repaired by 2-strand core sutures with immobilization by below-elbow splint. So we believe that in children the suture technique and type of immobilization had a great influence on the final outcome following flexor tendon injuries. INTRODUCTION he treatment of flexor tendon injuries in the hand generally requires special care in order to prevent long term sequelae, and the restoration of satisfactory finger performance remains as one of the most difficult and challenging problems. In children flexor tendon injuries are complicated problem and there are still poor outcome because of delay in diagnosis, small fingers with small size flexor tendons which make the repair technically difficult requiring great expertise, and in addition the inability of young child to cooperate after surgery. The proper surgical repair techniques, postoperative immobilization methods and the rehabilitation protocol affect the rate of healing, the strength of the repair and final tendon gliding. Recently, it is reported that primary repair of the flexor tendon injuries in children produces better results than in adults, because healing is more quick, and have a greater ability to remodel scars and adhesions and rarely develop contractures. The purpose of this article is to evaluate the effect of the repair technique and types of postoperative immobilization on the functional outcome after flexor tendon repair in children. PATIENTS AND METHODS This comparative study between two operative management of pediatric flexor tendon injuries was conducted between April 2001 and Dec 2007 at Basrah General Hospital and only 26 patients (35 fingers) less than 16 years old with sufficient follow up time were included. Cases with the thumb injuries, associated fractures, and with crush injuries were excluded. Fifty eight percent were males and 42% females, the age of the patients ranged from 1.5 to 15 years. In 77% of the patients, tendons were lacerated by glass, 32 digits (91%) had injury to both flexor digitorum superficialis (FDS) and flexor digitoram profundus (FDP) tendons and in only 3(9%) just the FDP tendon was injured. In 20 patients (77%) the right hand was involved. Tendon injuries occurred in zone II in 9 fingers (34%), zone III in 14(54%), zone IV in 1(4%) and zone V in 2 (8%). In all these cases, we performed surgery within 3 weeks after injury with direct end to end repair. The injured tendons were repaired by nonabsorbable sutures (4/0 and 5/0 Prolene), in 17 patients (65%) (23 digits) we use the 4-strand core sutures (cruciate technique) combined with interrupted epitendinous suture and with 2-strand repair technique in 9(35%) (13digits). Postoperatively, immobilization by above-elbow dorsal splint with the wrist, metacarpophalangeal joint (MP) and interphalangeal joints (IP) in flexion applied in 19 patients (73%) and below elbow splint in 7(27%) for a period of 4 weeks without passive motion. After that the splint was removed and active mobilization started. The results were assessed according to the Louisville evaluation system depending on pulp-to-distal palmar crease (DPC) distance and the extension deficits. The criteria in this system as follows: Excellent; Flex within 1cm of DPC with less than 15 degrees of extension deficit. Good; Flex within 1.5 cm of DPC with less than 30 degrees of extension deficit. Fair; Flex T MJBU, VOL 26, No.1, 2008 66 within 3 cm of DPC with less than 50 degrees of extension deficit. Poor; Flex over 3 cm with DPC or extension deficits over 50 degrees. RESULTS The average period of postoperative follow up was 9 months (range 4 to 24), the outcome was recorded after surgery and during the follow up period examination. Generally the excellent results were seen in 12 patients (46%), good in 8(31%), and poor in 6 patients (23%). (Table-) Table 1. Results of tendon repair

REPAIR OF THE FLEXOR TENDON INJURIES OF THE HAND IN CHILDREN: ANALYSIS OF THE REPAIR TECHNIQUES AND TYPE OF IMMOBILIZATION