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American Association for Hand Surgery

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Extensor Tendon Repair Outcomes Based on Timing of Repair
Stewart S Dalton, MD1, Laura M García, MS2, Hayyan Yousuf, BS2 and William F Pientka II, MD3, (1)JPS Health Network, Fort Worth, TX, (2)The University of North Texas Health Science Center, Texas College of Osteopathic Medicine, Fort Worth, TX, (3)John Peter Smith Hospital, Fort Worth, TX

Introduction: The extensor mechanism of the hand and fingers is composed of an intricate balance muscles and tendons that lie superficially and are vulnerable to injury. The relationship between the timing of extensor tendon repair after injury and patient outcomes is not well established. We aim to determine if a correlation exists between the time from injury to extensor tendon repair and patient outcomes. Our primary outcome is post-surgical function measured in final active digital extension and flexion. Secondary outcomes include return to full activity and surgical complications.
Materials & Methods: A retrospective chart review was conducted on all patients that underwent extensor tendon repair at our institution. The minimum follow-up time was 8 weeks. Patients were divided into two cohorts for analysis; those that underwent repair less than 14 days after injury and those that underwent extensor tendon repair at or greater than 14 days after injury. Data analysis was then completed using a two-sample t-test assuming unequal variance and ANOVA for categorical data.
Results: 137 digits were included in final data analysis, with 110 digits repaired < 14 days from injury and 27 digits repaired ≥ 14 days from injury. There was no significant difference in race, history of diabetes, hemoglobin A1C, or tobacco use between cohorts. A significant difference was found regarding insurance status between the two groups (p=0.038) with more uninsured or underinsured patients receiving treatment earlier. The average time between injury and repair was 7.2 days in the < 14 days to surgery group and 43.5 days in the ≥ 14 days to surgery group (p=<0.00001). There was no significant difference in final total active motion in either group (179.9 vs. 160.9 degrees, p= 0.22). There was no significant difference in final extension between the two groups (5.3 vs. 7.7 degrees, p= 0.74). Mean follow-up was 12.6 weeks. Two postoperative tendon ruptures were identified in the <14 days group and 0 in the ≥14 days group (p=.507).
Conclusions: In this study, we found that time from extensor tendon injury to surgical repair did not affect final range of motion or complication rates when comparing repair within 2 weeks from injury to repair greater than 14 days from injury. Additionally, there was no difference in return to activity or complications. Our findings are novel in that no previous study has been identified that specifically addresses extensor tendon repair outcomes based on timing of repair after injury.


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