الفهرس 
Introduction
AnatomyOnly 14 pages are availabe for public view
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Abstract
Flexor tendon injuries occur most commonly in association with lacerations or other open wounds of digits, and in such situations the surgical approach therefore is dictated to some extend by the nature of the wound. Flexor tendon injuries in the palm, wrist and/or forearm tend to be simpler to expose and repair in part because of the absence of the constricting fibro-osseous sheath, but when zone II the rate of incidence adhesions and stiffness remains one of most common complications.Although four strand suture methods still enjoy widespread acceptance, newer multi-strand suture methods are being used with increasing frequency because they are stronger and have increased resistance to repair site gapping.Despite advances in suture methods and understanding of the biology of the repair site, the formation of adhesions between the tendon and the surrounding fibro-osseous sheath with resultant digital stiffness remains one of the most common complications after intra-synovial flexor tendon repair.In an effort to improve the accrual of strength at the tendon repair site, investigators have advocated rehabilitation methods that generate increased levels of applied in vivo force across the repair.The aim of this work was to compare the clinical and functional outcome of flexor tendon repair of the hand using four -strand and six- strand modified Kessler core sutures.The study was conducted for twenty patients with acute flexor tendon zone two injuries recruited from the emergency department. The study was conducted in Orthopedic Microsurgery unit; Assiut University Hospital.The study show that their’s significant difference between the mean of angle of extension at PIPJ after 6 weeks of follow up , and the mean angle of extension at PIPJ after 12 weeks of follow up,In the studied groups, it was found that the mean of angle of extension at PIPJ after 3 weeks of follow up, in group A was -44.60 ± 20.64 degree. While in group B the mean was -33.90 ± 25.62 degree. There was a significant statistical difference between both groups as regarding angle of extension at PIPJ (p value = 0.018) with a higher mean in group B. On assessing the mean of angle of extension at PIPJ after 6 weeks of follow up, in group A was -31.30 ± 22.78 degree. While in group B the mean was -17.40 ± 27.36 degree. There was a significant statistical difference between both groups as regarding angle of extension at PIPJ (p value = 0.029) with a higher mean in group B.While on assessing the mean angle of extension at PIPJ after 12 weeks of follow up, in group A was -8.20 ± 22.68 degree. While in group B the mean was 3.70 ± 29.93 degree. There was a significant statistical difference between both groups as regarding angle of extension at PIPJ (p value = 0.027) with a higher mean in group B.On assessing the mean angle of extension at DIPJ after 12 weeks of follow up, in group A was -14.11 ± 3.26 degree. While in group B the mean was -7.75 ± 4.53 degree. There was a significant statistical difference between both groups as regarding the angle of extension at DIPJ with a higher mean in group B.Conclusion And RecommendationIn this study, we found that there’s no statistically significant difference between six strand triple modified Kessler repair and the four strand double modified Kessler repair. As regard to angle of Flexion at PIPJ ,Also,ther e,s we found that there’s no statistically significant difference between six strand triple modified Kessler repair and the four strand double modified Kessler repair. As regard to angle of Flexion at DIPJ after 3, 6, 12 weeks of follow up.It was also found that six strand repair gives statistically better result as regard to angle of Extension at PIPJ .Also six strand repair gives comparable outcome promoting early physiotherapy and rehabilitation that affect the outcome later on.In the light of the results and conclusions of the current study, We recommend that six strand repair of flexor tendons zone two injury to be applied when ever possible although fours and suture still working with good comparable results .There was a significant statistical difference between both groups as regarding the angle of extension at PIPJ after 3, 6, 12 weeks of follow up.