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Retrospective Analysis and Accuracy of Preoperative Examinations in Volar Wrist Lacerations
Ja Hea Gu, MD,PhD; Su Hyun Choi, MD; Dong Hee Kang, MD, PhD
Dankook University Hospital, Cheonan, Korea
Introduction: Some reports have indicated that the preoperative misdiagnosis rate of volar wrist lacerations on zone 5 is very high. We conduct a comprehensive review of demography, vector and cause of injury, results of zone 5 wrist lacerations and sought to ascertain the differences between the results of preoperative examinations and actual intraoperative deficiencies.
Materials and Methods: From July 2001 and June 2014, a total of 255 patients with zone 5 wrist lacerations were reviewed retrospectively. A total of 255 patients with Zone 5 wrist lacerations were reviewed retrospectively. Sex, age, vector, cause of injury, wound length, injured structures, and results were reviewed thoroughly. The preoperative diagnosis by the first examiner(Emergency department doctor or junior residents in plastic and reconstructive surgery department, most commenly) and postoperative diagnosis by the operator (hand surgeon) were compared and error rates were calculated. The correlations between the wound length, vector, cause of injury, and number of injured structures were analyzed statistically.
Results: The most common cause of injury is self-inflicted wrist injury followed by incidental accident, industrial accident and the glass is the most common vector. Fifty four patients underwent primary repair only and 191 patients explored then underwent teno-neuro-arteriorraphy. The most common injured structure was palmaris longus followed by flexor carpi radialis, flexor carpi ulnaris and median nerve. Over 60% patients resulted in excellent recovery and 8 patients resulted in claw hand deformities (5 patients), ape hand deformity ( 2 patient), complex regional pain syndrome (1 patient). The cause and vector of injury did not correlate with the number of structures that were cut. The preoperative examination significantly underestimated the amount of damage to tendons, arteries, and nerves. Fifteen out of the 255 patients (5.9%) were referred after primary repair. Each of the fifteen patients missed served structures from 3 to 10. The mean error rate of preoperative misdiagnosis was 30.6%. Superficial structures such as Palmaris longus, flexor carpi radialis and flexor carpi ulnaris were misdiagnosed at a rate of under 20%. However, fourth and fifth flexor digital profundus and radial artery were misdiagnosed at a rate of more than 50% preoperatively. Correlation between the mean length of wounds and the number of injured structures had an imperfect positive correlation(R2=0.183, p<0.05).
Conclusion: In Zone 5 wrist laceration cases, the misdiagnosis rate is high, as the preestimation of injuries is difficult. Therefore, exploration is recommended if laceration was involved over the dermis layer.
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