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Injury-Specific Factors Impact Outcomes Following Flexor Tendon Repair
Akhil Dondapati, MD
1; Andrew Rodenhouse, MD
2; Gilbert Smolyak, BS
1; Thomas J Carroll, MD
1; Giap Vu, MD
1; Gabriel Ramirez, PHD
1; Constantinos Ketonis, MD, PhD
11University of Rochester Medical Center, Rochester, NY; 2University of Rochester, Rochester, NY
Introduction: The purpose of this study was to evaluate injury-specific factors that impact outcomes and complications following flexor tendon repair. We hypothesize that certain injury-specific factors would influence patients' total active motion (TAM), days to discharge from hand therapy and return to work, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores.
Methods: This was a retrospective study of patients that underwent primary flexor tendon repair at a single, large academic institution between 2015-2023. Demographic information, injury-specific factors, patient-reported outcomes, and complication rates were collected. Mixed-effects linear regression, logistic regression, and negative binomial regression were performed. Statistical significance was defined with a p-value < 0.05.
Results: This study included 397 patients. Compared to the index finger, the ring and small fingers had lower TAM by 18.3° and 22.1°, respectively. Digits with Zone 1 injuries had improved TAM than Zone 2 injuries at both 6- and 12-weeks post-operatively. The improvement was noted to be 46.7° and 31.1° degrees, respectively. Those with concurrent digital nerve injuries had TAM decreased by 13.6° and 20.6° at 6- and 12-weeks post-operatively. TAM in patients with concurrent fractures worsened by 35.7° at 6-weeks. Patients with sawblade injuries had increased odds of compliance with hand therapy. Additionally, they had 83% more days until return to work and 25% more days until discharge from hand therapy than those with lacerations. These patients also had significantly worse PROMIS physical function and pain interference at 12-weeks and PROMIS depression at 6-weeks. Patients with multiple injured digits had 32% more days until discharge from hand therapy relative to those with single digit injuries.
Conclusions: After flexor tendon repair, the ring and small fingers, injuries in Zone 2, and patients with concurrent digital nerve injuries and fractures have decreased TAM. Additionally, those with multiple injured digits had increased days to discharge from therapy. Patients with sawblade injuries have greater odds of therapy compliance, but worse PROMIS scores and increased days to return to work and discharge from therapy.
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