Diagnostic accuracy of preoperative clinical examination in zone V flexor injuries

Abstract

BackgroundZone V flexor tendon injuries are devastating and may result in significant morbidity. There may be remarkable differences between preoperative clinical and the intraoperative findings of zone V flexor injuries. In this study, we assessed the demographics of patients presenting with zone V flexor injuries and the diagnostic accuracy of preoperative clinical examination. MethodsThis was a prospective study of patients who presented with zone V flexor injuries at an emergency department of a tertiary academic hospital for a period of one year. The demographic data were analysed and the preoperative clinical examination findings were compared to the definitive intraoperative findings to assess the accuracy of the former. The one-sample test for proportion was used to assess if the difference between the two findings was statistically significant. ResultsZone V flexor injuries occurred predominantly in males under 40 years of age. Assault was the leading cause of these injuries. Alcohol intake was a significant factor for the causes of these injuries. Almost one-third (33%) of lacerated anatomical structures were missed and 91% of partially lacerated anatomical structures were inaccurately diagnosed. The mean number of errors of the clinical examination was 3.55; only 9% of the clinical examination had no error and 42% had four or more errors. ConclusionThere was a significant difference between preoperative clinical examination and intraoperative findings and we recommend that all zone V flexor injuries extending beneath the subcutaneous tissue should be explored in theatre.