A patient has an isolated closed zone II flexor tendon injury of the middle finger (between distal palmar crease and PIP joint flexion crease). Primary repair is planned. Which tendon repair technique involving a 4-strand or 6-strand core suture and a circumferential epitendinous suture is now preferred to allow early active motion postoperatively?

• A Modified Kessler 2-strand repair with protected passive mobilisation only
• B Bunnell criss-cross repair with prolonged immobilisation for 6 weeks
• C Tajima or Adelaide 4-strand repair with circumferential Silfverskiold suture enabling early active motion ✓
• D Kleinert method using a palmar pulley and rubber band traction for passive flexion only

Explanation

Zone II ('no man's land') flexor tendon repairs now use multi-strand (4-6 strand) core suture techniques (Tajima, Adelaide, Strickland, Tsuge) combined with a circumferential epitendinous suture to increase repair strength >4 kg, which is the threshold needed to permit early active mobilization. Early active motion protocols (Belfast, Manchester Short Splint) significantly reduce adhesion formation, the primary complication in zone II. The 2-strand Kessler repair lacks sufficient strength for early active motion. Bunnell repair causes tendon ischemia at crossing sutures. Kleinert's rubber band is a passive (not active) mobilization technique.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.