Aim: Although primary ßexor tendon repair in children yields satisfactory results, some children end up with poor function because of delay in diagnosis, technical difþculties and the inability to follow a structured rehabilitation program. The aim of this study is to evaluate the functional outcome after two stage reconstruction with the modiþed Paneva technique (which includes creating a loop between the proximal stumps of Flexor Digitorum Profundus and Superþcialis in the þrst stage and reßecting the latter as a Ç pedicled È graft through the pseudosheath created around the silicone rod, in the second stage) in children. Methods: Nine patients (9 digits) with a mean age of 8,2 years (range 3 Ð15) were treated for zone II lesions. Their pre-operative status in the Boyes and Hunter scale was grade two in 3, grade three in 3, grade four in 1 and grade þve in 2 patients. Results: After a mean of 42 months of follow-up (minimum 12 months), according to the Buck-Gramco scale there were 4 excellent, 4 good and 1 poor result and according to the revised Strickland scale 3 excellent, 5 good and 1 poor. Children over the age of 10 had slightly improved Total Active Motion (mean +350) compared to younger ones. No signiþcant length discrepancies were noted. Two postoperative infections were treated and one graft-related re-operation was necessary. Conclusions: Staged ßexor tendon reconstruction in children is technically feasible and efþcient. Delaying such a reconstruction in younger children does not seem justi-þed.

Aim: To study the carpal geometry in patients with symptomatic scaphoid non-union without arthritis or with early arthritic changes. Method: The preoperative x-rays of 58 patients were retrospectively reviewed and x-rays of 35 of those fulfilling strict criteria for true projections were digitized and measured using CAD methodology. Patients’ mean age was 31,3 years and mean time from fracture 50,4 months. The measured variables concerned the carpal height, possible displacement of the carpal bones and carpal instability. The Herbert and Fisher classification was used and two subgroups concerning the absence (14) or presence (21) of early arthritic changes were created. Results: 62,5% of the patients (including patients without radiologicaly obvious arthritis) were presented with increased radial height and radial inclination, 28% with an affected carpal height, 17% with ulnar translocation of the wrist and up to 48% (varying according to the method of measurement) with a DISI pattern of instability. No statistically significant differences could be established between the morphological groups or between the two subgroups concerning early arthritis. Conclusions: Carpal geometry in scaphoid non-union although altered does not seem to change significantly with the appearance of early arthritis and thus treating non-union with early arthritis with osteosynthesis and bone grafting seems justified. In view of our findings it seems appropriate to supplement this procedure with distal radial osteotomy or with temporary lunate stabilization in selected patients.