Flexor Tendon Injury Zone Classification and Management
Flexor Tendon Injury Zone Classification and Management: Flexor Tendon Injury → Clinical Examination → Injury Zone → Zone I (Distal to FDS) → Surgical R...
Interactive Decision Tree
Algorithm Steps
- ▶Start
Flexor Tendon Injury
- ●Action
Clinical Examination
Test FDP (DIP flexion) and FDS (PIP flexion with adjacent fingers extended)
- ◆Decision
Injury Zone
- ●Action
Zone I (Distal to FDS)
FDP only, distal to A4 pulley
- May require tendon advancement
- Or reinsertion to bone
- ■End
Surgical Repair
Primary repair within 2 weeks, early mobilization protocol
- ●Action
Zone II (Fibro-osseous Canal)
'No man's land' - FDP and FDS
- Technically demanding
- Risk of adhesions
- Core + epitendinous suture
- ●Action
Zone III (Lumbrical Origin)
Palm - between A1 pulley and carpal tunnel
- Better prognosis than Zone II
- Associated neurovascular injury common
- ●Action
Zone IV (Carpal Tunnel)
Under transverse carpal ligament
- Median nerve at risk
- May need CTR for access
- ●Action
Zone V (Forearm)
Proximal to carpal tunnel
- Muscle belly injuries
- Associated nerve/vessel injury
Guideline Source
ASSH Clinical Assessment: Flexor Tendon Injuries
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Zone II historically 'no man's land' - technically demanding
- Timing of repair affects outcomes
- Rehabilitation protocol critical
Applicable Regions
UK: BSSH similar guidelines
US: ASSH zone classification standard
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
Related Resources
Frequently Asked Questions
What is the Flexor Tendon Injury Zone Classification and Management?
The Flexor Tendon Injury Zone Classification and Management is a diagnostic clinical algorithm for Plastic Surgery. It provides a structured decision tree to guide clinical decision-making, based on ASSH Clinical Assessment: Flexor Tendon Injuries.
What guideline is the Flexor Tendon Injury Zone Classification and Management based on?
This algorithm is based on ASSH Clinical Assessment: Flexor Tendon Injuries (DOI: 10.1016/j.jhsa.2019.02.008).
What are the limitations of the Flexor Tendon Injury Zone Classification and Management?
Known limitations include: Zone II historically 'no man's land' - technically demanding; Timing of repair affects outcomes; Rehabilitation protocol critical. Individual patient factors may require deviation from these recommendations.
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