Tendon Tendon injuries injuries Robert Spławski MD, PhD Paweł Surdziel MD, PhD Department of Traumatology and Hand Surgery University of Medical Sciences University of Medical Sciences in Poznan in Poznan Head of Department: Head of Department: Prof. Władysław Manikowski Prof. Władysław Manikowski
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Tendon injuries Robert Spławski MD, PhD Paweł Surdziel MD, PhD Robert Spławski MD, PhD Paweł Surdziel MD, PhD Department of Traumatology and Hand Surgery.
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Department of Traumatology and Hand SurgeryDepartment of Traumatology and Hand Surgery
University of Medical SciencesUniversity of Medical Sciences in Poznan in PoznanUniversity of Medical SciencesUniversity of Medical Sciences in Poznan in Poznan
Head of Department:Head of Department:Prof. Władysław ManikowskiProf. Władysław ManikowskiHead of Department:Head of Department:Prof. Władysław ManikowskiProf. Władysław Manikowski
Historical notesHistorical notes
Tendon surgery is as old as surgery Tendon surgery is as old as surgery itselfitself
Hippocrates – if injury of Achilles tendon occurHippocrates – if injury of Achilles tendon occurs it would s it would cause acute fever, convulsins etc.cause acute fever, convulsins etc.Avicenna - tenth century strongly advocated tendon sutureAvicenna - tenth century strongly advocated tendon sutureWorld War I and II stimulated the development of modern World War I and II stimulated the development of modern hand hand surgerysurgery
structural proteins, plasma proteins and other small molecules)structural proteins, plasma proteins and other small molecules)
CollagenCollagen
typI – composed of three chains typI – composed of three chains 70% glicine, 15% proline and 15% hydroxyproline70% glicine, 15% proline and 15% hydroxyproline
Collagen molecules are combined in a right-handed tripleCollagen molecules are combined in a right-handed triplehelix. helix. The sThe stabilisation between helixs tabilisation between helixs is maintain is maintain by by hydrogens bonds.hydrogens bonds.
2.2. Controlled passive motion -Controlled passive motion -Duran-HouserDuran-Houser method method /active motion after 5 weeks//active motion after 5 weeks/
3.3. Controlled active motion methodControlled active motion method..
Active extension-passive flexion
PM
CAM
Tendon reconstructionTendon reconstruction
Primary end to end tendon suture. To 3-4 weeks.Primary end to end tendon suture. To 3-4 weeks.Secondary - staged techniquesSecondary - staged techniques
single stage – good conditionssingle stage – good conditions
two stage – after complicated injuristwo stage – after complicated injuris1-st stage – endoprothesis1-st stage – endoprothesis2-nd stage – tendon graft.2-nd stage – tendon graft.
Short – zone 1-3Short – zone 1-3Long – zone 1-5Long – zone 1-5
Prostowniki
Mallet fingerMallet finger
Type I- closed trauma , with or without small avulsion fracture
Type II- laceration, loss of tendon continuity
Type III- II+deep abrasion
Type IV- A-transepiphiseal plate fracture; B- fracture of artic. surf. 20-50%; C- fracture of artic. surf. >50% , or subluxation aDIP
Zone I
Zone I
Zone II
1.1.Open injuryOpen injury – – tendon suturetendon suture; ; immobilization in immobilization in hyperextension for 6 weekshyperextension for 6 weeks..
2.2.Closed injury- Closed injury- split in hyperextension insplit in hyperextension in aPIP aPIP
Zones III, IV,V
Open injury:- tendon suture, immobilization aPIP 0° to 5-6 weeks -
exercise- Zone V – wrist immobilization in flexion 40°. MP joints in
flexion 10-20°.
Closed injury:- splint for 6 weeks
Zones VI-IX
End to end tendon suture.Immobilization – wrist in hyperextension 40-45° for 4-5 weeks