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Flexor Tendon Injuries - Does Longer Time to Surgery result in Worse Outcomes?
Shahab Shahid, MBBS, BSc, PGCert, MRCS; Sebastian Kosasih, MBBS, BSc, MRCS; Ben Miranda, BSc MBBS(Lond) MRCS(Eng) FRCS(Plast) EBHS(FESSH) DipHandSurg(BSSH) PhD
St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, Essex, United Kingdom
Aims Primary aim: To determine if time to repair impacts eventual TAM (Total Active Mobilisation) and QDASH (Quick Disabilities of the Arm, Shoulder and Hand questionnaire) scores in flexor tendon injuries. Secondary aim: To determine if patient sex, patient comorbidities, repair technique, damage to other structures, engagement with hand therapy and engagement with outpatient follow up impact hand function and patient symptoms following flexor tendon injury.
Method Data collected were from injuries that occurred between December 2020 to August 2022 at a single hand trauma unit. Data collected included patient demographics (sex, age, job) injury details (injured fingers, injured structures), surgery details (suture material used, repair technique, post operative complications) and eventual hand function (Total active motion, QDASH Score).
Results 165 patients with 199 flexor tendon injuries were included in the analysis. Median age was 33 (IQR 23-45), males were 77.0% of the cohort (129/165).
Repair in 6 days or less (when compared with repair after 6 days) was associated with a better QDASH score (p=0.004). 2 digit injuries were associated with poorer QDASH compared with 1 digit injuries (p=0.03). Common digital artery injury (p<0.01) and skin loss (p<0.01) were associated with reduced
TAM. Common digital artery injury (p<0.001) and intra-articular fracture (p=0.001) were associated with reduced QDASH. Zone 3 injuries were associated with better QDASH (p<0.001) and TAM (p<0.001) when compared to zone 1 injuries. Silfverskiold epitendinous repair (20.0%, 25/125) was associated with higher TAM on linear regression (p=0.046). Multivariate regression analysis indicated that better QDASH scores were associated with shorter injury to surgery times (p<0.001), non-attendance to scheduled
outpatient appointments (p=0.04), and increased TAM (p<0.001
). Poorer TAM outcomes were associated with smoking (p<0.001), diabetes (p=0.015), and full attendance to scheduled outpatient appointments (p<0.01).
Conclusion O
ur findings support the benefit of early flexor tendon repair (?6 days) on QDASH scores following flexor tendon injury. Patient factors such as smoking status and diabetes and injury factors such as zone 1 injuries, intraarticular fracture, and concurrent digital artery injury were associated with poorer outcomes. Further studies are necessary to further determine factors effecting flexor tendon outcomes.
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