Complex hand injuries are those which involve more than one functionally significant anatomic structure of the hand (i.e vessels, nerves, tendons, bones). The epidemiologic and management characteristics of these injuries, encountered in a specialized center covering an urban and agricultural population, were recorded and studied.

Between 1997 and 2002 the Orthopaedic Department of the University of Ioannina surgically treated 211 complex hand injuries in 190 patients with a mean age of 35 year (range 2.5–73). The majority of patients were male (89%). The incidence of these injuries was low at the extremes of the age distribution (children and adults over 60 years old). The greatest incidence was in the 15–30 year old age group. The mechanism of the injury was found to be clean cut trauma in 31% and avulsion or crushing in 69%; with the later being frequent agricultural injuries. Fifty-nine per cent of the injuries were viable, while 41% where non-viable (complete amputation in 63% and incomplete in 37%). Of the non viable injuries 66% eventually underwent stump configuration. Primary repair of only one anatomical structure was performed in 58%, most commonly osteosynthesis and tendon suturing. In 42% primary repair of more than one structure was performed, most commonly osteosynthesis and tendonorrhaphy in avulsion injuries and neuroraphy combined with tendonorrhaphy in clean cut injuries.

Complex hand injuries are frequently seen in young male adults and the most common mechanism of injury is avulsion-crushing. Most of them are work-related accidents, so prevention should focus on adherence to safety guidelines. Management of such injuries requires special surgical techniques and expertise, necessary for staged reconstruction.

Although primary flexor tendon repair in children yields satisfactory results, some children end up with poor function because of delay in diagnosis, technical difficulties 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 modified Paneva technique (which includes creating a loop between the proximal stumps of Flexor Digitorum Profundus and Superficialis in the first stage and reflecting the latter as a “pedicled” graft through the pseudosheath created around the silicone rod, in the second stage) in children.

Nine patients (nine digits) with a mean age of 8.2 year (range 3–15) were treated for zone II lesions. Their pre- operative status in the Boyes and Hunter scale was grade 2 in three, grade 3 in three, grade 4 in one and grade 5 in two patients.

After a mean of 42 months of follow-up (minimum 12 months), according to the Buck-Gramco scale there were four excellent, four good and one poor result and according to the revised Strickland scale three excellent, five good and one poor. Children over the age of 10 had slightly improved Total Active Motion (mean +35°) compared to younger patients. No significant length discrepancies were noted. Two postoperative infections were treated and one graft-related re-operation was necessary.

Staged flexor tendon reconstruction in children is technically feasible and efficient. Delaying such a reconstruction in younger children does not seem justified.