1
|
Daniels SP, Kirby D, De Tolla J. Diagnosis and treatment of flexor tendon injuries of the hand: what the radiologist needs to know. Skeletal Radiol 2024; 53:597-608. [PMID: 37828095 DOI: 10.1007/s00256-023-04460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
This article reviews the diagnosis and treatment of flexor tendon injuries of the hand highlighting flexor tendon anatomy, important pre-operative imaging findings, surgical options, and post-operative complications. Imaging plays a key role in guiding treatment of these difficult to manage injuries. Thus, it is important for radiologists to have a sound understanding of factors important in treatment decision-making. In the pre-operative setting, accurately identifying the location of the torn proximal tendon stump in subacute and chronic injuries helps dictate whether the patient is a candidate for a primary flexor tendon repair or may require a tendon reconstruction to restore function. In the post-operative setting, the status of the repair and presence of surrounding adhesions help dictate if and when the patient will require subsequent surgery and whether that surgery will be a tenolysis, revision repair, reconstruction, or fusion.
Collapse
Affiliation(s)
- Steven P Daniels
- Department of Radiology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - David Kirby
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Jadie De Tolla
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| |
Collapse
|
2
|
Tobler-Ammann BC, Beckmann-Fries V, Calcagni M, Kämpfen A, Schrepfer L, Vögelin E. Outcomes of Primary Flexor Tendon Repairs in Zones 2 and 3: A Retrospective Cohort Study. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:445-453. [PMID: 37521557 PMCID: PMC10382891 DOI: 10.1016/j.jhsg.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/31/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose The aims of this retrospective cohort study were to present outcomes of zone 2 and 3 primary flexor tendon repairs and to evaluate how clinical outcomes change over time within and between zones of injury at weeks 6, 13, and 26. Methods Data were retrieved from a multicenter flexor tendon cohort registry from 2014 to 2021. The inclusion criteria were: (1) adult patients after primary flexor tendon surgery in zone 2 or 3, (2) flexor digitorum profundus laceration of >50%, (3) 4-6 multistrand flexor digitorum profundus core suture, and (4) early active motion protocol. The primary outcome was the range of motion. Secondary outcomes were strength, patient satisfaction on an 11-point Likert scale, and self-reported physical function measured with the Disability of the Arm, Shoulder, and Hand questionnaire 6, 13, and 26 weeks after surgery. Results We evaluated 33 patients after 39 tendon repairs in zone 3 and 174 repairs in zone 2 of 163 patients. Range of motion significantly improved over time in both zones (P < .001 to .01). Between-group range of motion differences were nonsignificant except for week 26 (P < .001) for the zone 3 group. Hand strength significantly improved in both zones over time (P < .001 to .01), while between-zone strength differences were statistically nonsignificant (P = .37 to .93). Patient satisfaction was generally good to high (mean 6.8 to 8.0 points) with significant within-group changes in both zones (P < .001). There were no relevant between-zone differences in Disability of the Arm, Shoulder, and Hand scores at any time point. Conclusions Patients had significantly improved clinical outcomes in both zones. The zone of injury significantly affected the total active motion scores at the final assessment after 26 weeks for the zone 3 injuries. For the secondary outcomes hand strength, patient satisfaction, and Disability of the Arm, Shoulder, and Hand scores, we discovered no significant between-group differences. Type of study/level of evidence Therapeutic IV.
Collapse
Affiliation(s)
| | - Vera Beckmann-Fries
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alexandre Kämpfen
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Lorena Schrepfer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Esther Vögelin
- Department of Plastic and Hand Surgery, Inselspital Bern, University of Bern, Bern, Switzerland
| |
Collapse
|
3
|
Aletto C, Aicale R, Oliva F, Maffulli N. Hand Flexor Tendon Repair: From Biology to Surgery and Rehabilitation. Hand Clin 2023; 39:215-225. [PMID: 37080653 DOI: 10.1016/j.hcl.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Tendon biology and anatomy are crucial to manage hand flexor tendon injuries, not only for surgical treatment but also for rehabilitation; surgeon and physical therapist have to choose zone by zone the best way to manage and restore the normal function of hand flexor tendons.
Collapse
Affiliation(s)
- Cristian Aletto
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84084, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno 84131, Italy.
| | - Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84084, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno 84131, Italy
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84084, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno 84131, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84084, Italy; Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno 84131, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England; Keele University, Faculty of Medicine, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB, UK
| |
Collapse
|
4
|
Starr BW, Cornwall R. Pediatric Flexor Tendon Injuries. Hand Clin 2023; 39:227-233. [PMID: 37080654 DOI: 10.1016/j.hcl.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
The diagnosis and management of pediatric flexor tendon injuries present unique challenges to the hand surgeon. Examination of young children is not always straightforward, and tendon lacerations are frequently diagnosed late--sometimes weeks or months after the inciting injury. Four- and six-strand repair techniques are supported by recent literature, though the surgeon must remain diligent to ensure gliding of a bulky repair in a narrow tendon sheath. Beyond the operating room, postoperative management must be tailored to accommodate nuances specific to patient age and behavioral development. A fluid, patient-specific approach to every stage of management is critical for the successful treatment of pediatric flexor tendon injuries.
Collapse
Affiliation(s)
- Brian W Starr
- Division of Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Roger Cornwall
- Division of Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| |
Collapse
|
5
|
Jo S, Calfee RP. General Principles of Flexor Tendon Repair. Hand Clin 2023; 39:131-139. [PMID: 37080645 DOI: 10.1016/j.hcl.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Flexor tendon repair techniques and rehabilitation have advanced tremendously in the past 50 years. However, the attributes of the ideal tendon repair articulated by Dr Strickland in 1995 hold true today. The ideal repair requires sutures easily placed in the tendon, secure suture knots, a smooth juncture of the tendon ends, minimal gapping, least interference with tendon vascularity, and sufficient strength throughout healing. When accomplished, the modern flexor tendon repair is a stout repair, sufficient for early mobilization and intrinsic tendon healing.
Collapse
Affiliation(s)
- Sally Jo
- Department of Orthopedic Surgery, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8233, St. Louis, MO 631, USA
| | - Ryan P Calfee
- Department of Orthopedic Surgery, Washington University School of Medicine, 660 S Euclid Avenue, Campus Box 8233, St. Louis, MO 631, USA.
| |
Collapse
|
6
|
Fulchignoni C, Bonetti MA, Rovere G, Ziranu A, Maccauro G, Pataia E. Wide awake surgery for flexor tendon primary repair: A literature review. Orthop Rev (Pavia) 2020; 12:8668. [PMID: 32913601 PMCID: PMC7459365 DOI: 10.4081/or.2020.8668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 11/24/2022] Open
Abstract
Flexor tendon injuries are extremely challenging conditions to manage for hand surgeons. Over the last few years enormous progress has been made for the treatment of these lesions with new surgical approaches being performed. One of these is the wideawake local anesthesia no tourniquet (WALANT) technique, also known as Wide Awake Technique that allows tendon repair under local anesthesia, enabling the tendon to move actively during surgery. Dynamic movement of the tendon during surgery is crucial for the orthopedic surgeon in order to understand if the tendon has been correctly repaired before leaving the operatory table. An electronic literature research was carried out on Pubmed, Google Scholars and Cochrane Library using ((Flexor tendon injury) OR (flexor tendon) OR (injury muscle tendon) OR (flexor pollicis longus tendon) AND ((wide awake repair) OR (wide awake) OR (wide awake hand surgery))as search terms. Authors believe that WALANT is an enormous add-on in the management of patients with flexor tendon injuries mainly because it allows direct visualization of the repair during flexion and extension movement of the fingers and also because it avoids general anesthesia or brachial plexus being more cost effective. The aim of these review was therefore to sum up the evidences available so far on the wade awake technique as an emerging treatment for patients with flexor tendon injuries.
Collapse
Affiliation(s)
- Camillo Fulchignoni
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Mario Alessandri Bonetti
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Antonio Ziranu
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giulio Maccauro
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Elisabetta Pataia
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| |
Collapse
|
7
|
Dawood AA. Repair of flexor tendon injuries by four strands cruciate technique versus two strands kessler technique. J Clin Orthop Trauma 2020; 11:646-649. [PMID: 32684704 PMCID: PMC7355087 DOI: 10.1016/j.jcot.2020.05.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Flexor tendon injuries are commonly encountered and the surgical repair still represents a challenging problem. Many repair techniques are present but there is still no ideal one that achieves the best functional outcome. This study was undertaken to compare four-strand locked cruciate repair technique and modified Kessler technique in forty eight patients by assessing the functional outcome. METHODS Forty eight patients (114 digits) with flexor tendon injury were assigned into two groups based on suture repair technique; Group A: 24 cases by Modified Kessler repair (50%). Group B: 24cases by 4-strand cruciate repair (50%). Adults in Both groups were rehabilitated by combined Duran protocol and early active mobilization while no specific rehabilitation program was used for pediatric age group. Follow up was from 6 to 36 months (mean 21.5). Functional outcome was assessed by White criteria to all patients after 6 months. RESULTS Functional outcome was better in 4 strand cruciate repair with excellent result in 66.6%, good in 29.1% and fair in 4.1%, as compared to modified Kessler technique in which excellent results were found in 45.8%, good in 37.5%, fair in 12.5% and poor in 4.1% of cases. A better functional result was achieved in 4 strand cruciate repair especially in zone II, with excellent results in 33.3%, good in 50% and fair in 16.6% of cases, as compared to modified Kessler repair with no excellent results, 33.3% good, 50% fair and 16.6% poor results. In zone III, 4 strand cruciate technique showed a better functional outcome with 77.7% excellent and 22.2% good results, as compared to 55.5% excellent and 44.4% good results found in Modified Kessler repair. Zone V showed almost comparable results between the two types of repairs. CONCLUSION The 4-strand cruciate repair technique had better functional outcome compared to modified Kessler repair technique, especially in zone II and III.
Collapse
|
8
|
Ishak A, Rajangam A, Khajuria A. The evidence-base for the management of flexor tendon injuries of the hand: Review. Ann Med Surg (Lond) 2019; 48:1-6. [PMID: 31660149 PMCID: PMC6806617 DOI: 10.1016/j.amsu.2019.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/30/2019] [Accepted: 10/06/2019] [Indexed: 11/27/2022] Open
Abstract
There is no consensus on the optimal flexor tendon repair technique at each anatomical flexor zone. There is paucity of high quality evidence. Heterogenous study designs limit inter-study comparisons. Patient reported outcome measures are crucial but there is a perennial need for robust disease-specific tools to be utilised.
Collapse
Affiliation(s)
- Athanasius Ishak
- Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Science (CHAPS), King's College London, Strand, London, WC2R 2LS, United Kingdom
| | - Akshaya Rajangam
- Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Science (CHAPS), King's College London, Strand, London, WC2R 2LS, United Kingdom
| | - Ankur Khajuria
- Department of Plastic Surgery, St Thomas' Hospital, London, UK.,Kellogg College, University of Oxford, Oxford, UK
| |
Collapse
|
9
|
Postsurgical Rehabilitation of Flexor Tendon Injuries. J Hand Surg Am 2019; 44:680-686. [PMID: 31113704 DOI: 10.1016/j.jhsa.2019.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/07/2019] [Accepted: 02/18/2019] [Indexed: 02/02/2023]
Abstract
Rehabilitation after surgical repair of flexor injuries is a controversial topic. Motion at the repair site decreases risk for adhesions but increases risk for rupture. We review the current concepts behind various rehabilitation protocols based on zone of injury and the evidence behind each.
Collapse
|
10
|
Abstract
Flexor tendon injuries of the hand are uncommon, and they are among the most challenging orthopaedic injuries to manage. Proper management is essential to ensure optimal outcomes. Consistent, successful management of flexor tendon injuries relies on understanding the anatomy, characteristics and repair of tendons in the different zones, potential complications, rehabilitation protocols, recent advances in treatment, and future directions, including tissue engineering and biologic modification of the repair site.
Collapse
|
11
|
|
12
|
Usami S, Yamamoto M, Okazaki M. Intraoperative ultrasound-assisted repair of zone III flexor tendon rupture with a minimal incision. J Hand Surg Eur Vol 2016; 41:1003-1004. [PMID: 26329884 DOI: 10.1177/1753193415603017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- S Usami
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - M Yamamoto
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - M Okazaki
- Department of Plastic and Reconstructive Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
13
|
Chinchalkar SJ, Pipicelli JG, Agur A, Athwal GS. Zone III flexor tendon injuries - A proposed modification to rehabilitation. J Hand Ther 2016; 28:319-23; quiz 324. [PMID: 26089286 DOI: 10.1016/j.jht.2014.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/20/2014] [Indexed: 02/03/2023]
Abstract
In this manuscript, these authors have utilized years of clinical experience to suggest rehabilitation modifications for Zone III flexor tendon injuries. - VictoriaPriganc, PhD, OTR, CHT, CLT, Practice Forum Editor.
Collapse
Affiliation(s)
- Shrikant J Chinchalkar
- Department of Hand Therapy, St. Joseph's Health Care, London, Ontario, Canada; Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada
| | - Joey G Pipicelli
- Department of Hand Therapy, St. Joseph's Health Care, London, Ontario, Canada; Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.
| | - Anne Agur
- Department of Anatomy, Faculty of Medicine, The University of Toronto, Toronto, Canada
| | - George S Athwal
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Division of Orthopaedics, Western University, London, Ontario, Canada; Division of Orthopaedics, St. Joseph's Health Care, London, Ontario, Canada
| |
Collapse
|
14
|
Lee GJ, Kwak S, Kim HK, Ha SH, Lee HJ, Baek GH. Spontaneous Zone III rupture of the flexor tendons of the ulnar three digits in elderly Korean farmers. J Hand Surg Eur Vol 2015; 40:281-6. [PMID: 25005564 DOI: 10.1177/1753193414541221] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Spontaneous flexor tendon rupture is a rare condition and the aetiology is not clear. We report 12 elderly Korean farmers with spontaneous flexor tendon ruptures. We found the rupture in the dominant hand in ten patients. A rupture in the little finger was found in all 12 patients (seven with both flexor tendons ruptured and five with only the profundus ruptured), in the ring finger in four patients (the profundus ruptured in all and both flexor tendons in two patients), and in the middle finger a partial rupture of the profundus in one patient. The tendons were ruptured close to the hook of the hamate. Repetitive friction between the flexor tendons and the hamate hook may cause the ruptures. The hamate hook was excised and the ruptured profundus tendons were reconstructed with tendon transfers with quite favourable functional recovery at follow-up of 1 to 2 years. The ruptured superficialis tendons were not reconstructed. Level of Evidence IV.
Collapse
Affiliation(s)
- G J Lee
- MS Jaegeon Hospital, Seoul National University Hospital, Seoul, Korea
| | - S Kwak
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - H K Kim
- MS Jaegeon Hospital, Seoul National University Hospital, Seoul, Korea
| | - S H Ha
- MS Jaegeon Hospital, Seoul National University Hospital, Seoul, Korea
| | - H J Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - G H Baek
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
15
|
Dautel G. [Flexor tendons repair in zones 3, 4 and 5]. ACTA ACUST UNITED AC 2014; 33 Suppl:S44-7. [PMID: 25442407 DOI: 10.1016/j.main.2014.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/21/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022]
Abstract
Surgical repair of zones 1 and 2 flexor tendon injuries is a technically demanding procedure. Surgical repair of zones 3 to 5 lacerated flexor tendons is less demanding. The associated vascular and neural damage will impact the functional outcome. The surgical techniques used to repair flexor tendons in zones 3, 4 and 5 are described, along with the strategy used to treat any associated lesions.
Collapse
|
16
|
Hardwicke JT, Tan JJ, Foster MA, Titley OG. A systematic review of 2-strand versus multistrand core suture techniques and functional outcome after digital flexor tendon repair. J Hand Surg Am 2014; 39:686-695.e2. [PMID: 24576754 DOI: 10.1016/j.jhsa.2013.12.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 12/23/2013] [Accepted: 12/27/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine published evidence to evaluate the hypothesis that multistrand techniques result in a poorer outcome than 2-strand techniques for digital flexor tendon repairs. METHODS A systematic review was undertaken to compare outcomes and rupture rates between 2-strand and multistrand core sutures in digital flexor zones 2 to 5. Outcome was measured by the American Society for Surgery of the Hand criteria, original or modified Strickland criteria, or Buck-Gramcko criteria. RESULTS A total of 1,878 patients (2,585 digits; 3,749 tendons) were included from the selected studies. Thirty-three studies reported 2-strand repairs and 15 reported multistrand repairs. Of the total tendon injuries, 59% were flexor digitorum profundus, 38% were flexor digitorum superficialis, and 2% were flexor pollicis longus. The pooled rupture rate was 3.9 per 100 digits. No significant difference was detected between 2-strand and multistrand repairs for outcomes by all measures or rupture rate. CONCLUSIONS Because of the wide variation in reporting of outcomes and study design on which this analysis was based, we cannot definitively confirm our hypothesis. We present the standards for outcomes as well as rupture rate for digital flexor tendon repair. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
Collapse
Affiliation(s)
- Joseph T Hardwicke
- Birmingham Hand Centre, University Hospitals of Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Birmingham, United Kingdom; University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Jessica J Tan
- Birmingham Hand Centre, University Hospitals of Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Birmingham, United Kingdom; University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Mark A Foster
- Birmingham Hand Centre, University Hospitals of Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Birmingham, United Kingdom; University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - O Garth Titley
- Birmingham Hand Centre, University Hospitals of Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Birmingham, United Kingdom; University of Birmingham, Edgbaston, Birmingham, United Kingdom
| |
Collapse
|