Four-strands versus six-strands core sutures technique for surgical management of acute zone II flexor tendon injury

Document Type : Original Article

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Department of Orthopedic Surgery & Traumatology,Faculty of Medicine-Minia University

Abstract

This randomized prospective comparative study was conducted on 52 patients (60 fingers) who 
sustained acute zone 2 flexor tendon injury in the form of complete laceration of isolated FDP tendon 
or combined FDP and FDS tendons. All patients were operated in the period between March 2017 and 
January 2020 in Minia Hand and Microsurgery Unit (MHMU) in orthopaedic surgery department. 
The injured fingers were repaired using either a 4-strand or a 6-strand core suture repair by simple 
random selection using sealed envelope method. The patients were divided into 2 groups: Group A: 
Patients were managed by 4-strand; double modified Kessler core suture and Group B: Patients were 
managed by 6-strand; triple modified Kessler core suture. Post operatively, the patients were 
instructed to start early controlled active motion from the first day. Then, they were assessed regularly 
at the 4th, 8th and 12th week of rehabilitation for: Visual analogue scale (VAS), Grip strength and 
Total active motion (TAM). There was no significant differences in grip strength in both groups 
measured in comparison with the other normal side at all examination time point but the difference 
between TAM is significant all through measurement time points between the 2 studied groups. so, 
the 6-strand repair is superior to the 4-strand repair regarding the TAM and effective PIPJ and DIPJ 
flexion. It was also found that 6-strand repair gives a better range of extension through different interphalangeal joints.

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