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In-office ultrasound for the identification of partial zone II flexor tendon lacerations
Ian Zweifel, BA
1; Riley Onoszko, BA
1; Joshua M Adkinson, MD
2; Gregory H Borschel, MD
2; Anthony Archual, MD
1; Ryan Kozlowski, MD
1; Khusboo Desai, MD
1; Erin L Weber, MD, PhD
21Indiana University, Indianapolis, IN; 2Indiana University School of Medicine, Indianapolis, IN
Introduction:Point of care ultrasound (POCUS) is becoming increasingly popular in clinical settings and has recently been introduced into medical school curriculum. The increased utilization of ultrasound has allowed physicians to collect real-time images of the status of their patients. With regard to hand surgery, flexor digitorum profundus (FDP) lacerations greater than 50% width are classically believed to need surgical repair to prevent rupture. Clinical exam cannot differentiate between tendon lacerations that are less than full transections. Patients with suspected partial tendon lacerations are referred to radiology for ultrasound assessment. We sought to determine if hand surgeons, with minimal to no training in ultrasound technique, are able to identify partial FDP lacerations using ultrasound.
Materials and Methods:Twelve partial (20%, 40%, 60%, 80%) and three complete lacerations of the FDP tendon were created in zone II over the proximal phalanx of the index through small fingers of five cadaver hands. Identical dissections were performed on three additional digits, leaving the FDP tendon intact. The skin lacerations were then repaired. Seven hand surgeons from a level I academic trauma center used a FlexFocus 500 ultrasound machine to identify the percentage of each laceration. Data was analyzed for the frequency of correctly identifying the exact percent laceration as well as whether a tendon would need surgical repair (> 50% lacerated).
Results: The hand surgeons correctly identified the percent of tendon width laceration 24.6% (+/-10.6%) of the time, compared to 16.7% by chance. Surgeons correctly identified the need for surgical repair of tendons with greater than 50% tendon width lacerations at a rate of 54.0% (+/- 11.9%), which is not significantly different than a rate of 50% by chance. The hand surgeons were able to identify complete FDP lacerations with the most accuracy (81.0%). A Student's t-test was used to determine significance.
Conclusion: This study demonstrates that hand surgeons without ultrasound experience are unable to accurately detect partial zone II flexor tendon lacerations using ultrasound. Those surgeons wishing to utilize in-office ultrasound for diagnosis of flexor tendon injuries would benefit from formal training. As medical schools are adopting ultrasound into their curriculum and ultrasound training becomes the standard of care, the ability to use in-office ultrasound for partial tendon lacerations may improve.
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