Reconstructive Surgery for Zone 5 Closed Rupture of the Flexor Tendons of the Ulnar Three Fingers: Three Case Reports

Three older patients with closed ruptures of the flexor tendons of three ulnar fingers, resulting from distal radius malunion, underwent reconstructive surgeries using either free tendon grafts or extensor carpi radialis longus tendon transfers. Tendons were sutured with tension tighter than that of the unaffected index finger. Functional evaluation was fair in eight fingers and poor in one finger. Total active motion of all nine fingers remained limited immediately after surgery and did not show further decline postoperatively. Although the outcomes could be considered modestly acceptable, they were clinically suboptimal, highlighting the challenges of restoring fine motor function in chronic, multiple tendon injuries.