Treatment of tendon injuries in children.

Tendon injuries in the child's hand can be repaired primarily with better results than in the adult; this is true at all levels, including the digital sheath. In less than ideal circumstances, secondary conventional tendon grafting also provides predictable satisfactory results and can also salvage a failed primary repair. In children under the age of six years with digital flexor tendon repairs, the limb must be immobilized above the elbow. In the cooperative child over the age of six years with a primary repair of a lacerated flexor tendon, the dorsal splint with rubber band traction as described by Kleinert is recommended. Preoperative diagnosis of tendon injuries in the young child is difficult. If there is any doubt after observing the child using his hand, the wound must be explored and tendons and nerves identified to ensure their integrity. Even though the results of tendon repair in children are better than in adults, the structures are small, technique must be meticulous, and magnification must be used. Specially trained hand surgeons experienced in primary tendon repair and tendon grafting should perform these procedures, for this elegant structure deserves the finest attention.