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Correspondence to Author: Made Bramantya Karna¹, Anak Agung Gde Yuda Asmara¹, Stedy Adnyana Christian¹, Dary Gunawan². 

¹Consultant of Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia

²Resident of Orthopedic and Traumatology Department, Faculty of Medicine, Udayana University/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia

DOI: 10.52338/tjop.2025.4821

Abstract:

Background: Flexor tendon ruptures involving the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) are complex and challenging to treat. This case report illustrates a successful two-stage tendon reconstruction combined with early physiotherapy.
Case Presentation: A 29-year-old right-handed male presented with an inability to flex his right index finger six months post-injury. MRI showed a partial tear of the FDS, injury to the A2 pulley, and fibrotic tissue. Initial treatments failed to improve the condition. The patient underwent contracture release and a two-stage tendon reconstruction.
Discussion: The first stage involved contracture release surgery followed by second surgery of silicon rod placement to maintain the tendon tunnel and the last surgery consist of rod replacement with palmaris longus tendon graft. Early post-operative physiotherapy began three days post-surgery, focusing on place-and-hold exercises and active extension. At 12 months, the patient achieved nearly 90° flexion at the MCP and PIP joints, and 80° at the DIP joint, with grip strength reaching 77% compared to the unaffected hand. This aligns with literature supporting early rehabilitation.
Conclusion: This case supports the efficacy of two-stage tendon reconstruction and early physiotherapy for neglected flexor tendon ruptures. Further studies with larger cohorts are needed to validate and improve these treatment strategies.

Citation:

Made Bramantya Karna, Continuity Of Patient’s Compliance And Collaboration Between Surgery And Rehabilitation After 2nd Stage Of Flexor Tendon Reconstruction: A Case Report. The Journal of Orthopaedics 2025.