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Clinical Outcomes of Zone II Flexor Tendon Repair Depending on Mechanism of Injury
Trevor Starnes, MD, PhD1; Rebecca J. Saunders, CHT2; Kenneth R. Means Jr, MD1
1Union Memorial Hospital - Orthopaedic Hand Surgery, The Curtis National Hand Center, Baltimore, MD; 2Union Memorial Hospital - Hand Therapy, The Curtis National Hand Center, Baltimore, MD

Purpose: Zone-II flexor tendon repair continues to be a problem with imperfect solutions. During review of the current literature involving zone-II flexor tendon repair outcomes, we noted that multiple mechanisms of injury are all combined to make generalizations regarding the outcomes for zone-II flexor tendon repair.  The purpose of this study is to determine if the mechanism of injury - tearing (saw) versus sharp (knife) - has an effect on outcomes of zone-II flexor tendon repairs at least one year after injury.

Methods: We retrospectively analyzed all patients who underwent zone-II flexor tendon repair during the time period of 2001-2010 at our institution.  Patients with concomitant fracture were eliminated. The two study groups were: Group 1 - mechanism of injury - tearing, crush, or saw; Group 2 - mechanism of injury - sharp, knife or glass.  The primary outcome was total passive motion (TPM) and total active motion (TAM) at the PIP and DIP joints according to the Strickland / Glogovac criteria.  Secondary comparisons included strength, DASH score, percentage of postoperative tendon rupture, and percentage of patients requiring tenolysis.

Results: The saw group (Group 1) consisted of 13 patients with 17 fingers injured. The sharp group (Group 2) consisted of 21 patients with 24 fingers injured. The saw group had significantly inferior motion with a TPM of 133.8° 9.8° and a TAM of 86.2° 13.6° compared with the sharp group with a TPM of 159.8° 6.1° (p=0.02) and a  TAM of 114.3° 6.7° (p=0.05). There was not a significant difference in the DASH score or strength measurements.  Postoperative complications including tendon rupture rates were similar but secondary surgery was significantly increased in the saw group.  Regression analysis suggested a trend that repair of both flexor digitorum profundus and flexor digitorum superficialis in both saw and sharp injuries may lead to improved range of motion (p=0.07).

Conclusions: We have demonstrated that a tearing type of injury such as that caused by a saw leads to inferior outcomes compared with a sharp mechanism of injury at average follow-up of 4 years. This is clinically significant when discussing the expected outcomes from surgical intervention with patients. In the future, mechanism of injury in zone II flexor tendon lacerations may play a role in defining the optimal treatment course.

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