Prognostic factors for digital range of motion after intrasynovial flexor tendon injury and repair: Long-term follow-up on 273 patients treated with active extension-passive flexion with rubber bands

Edsfeldt, Sara; Eklund, Martin; Wiig, Monica

doi:10.1016/j.jht.2017.12.007

Cited by 14 publications

(13 citation statements)

References 20 publications

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“…Patient age and injury factors such as fracture, dysvasularity, multiple digit involvement, and associated extensor tendon injuries have all been found to affect range of motion outcomes. [5][6][7][8][9][10] However, while injury of the obtuse digital nerve(s) is exceedingly common, the evidence surrounding the impact of this concomitant injury is sparse and conflicting. 5,7,10,11 As such, it is the objective of this study to assess the impact of digital nerve injury on active range of motion (AROM) recovery after primary repair of the FDP in zone 2.…”

Section: Introductionmentioning

confidence: 99%

Does Digital Nerve Injury Affect Range of Motion Recovery After Zone 2 Flexor Tendon Repair?

Keane

Stonner

Pet

2021

Hand (New York, N,Y.)

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Background Evidence surrounding the impact of concomitant digital nerve injury on the outcome of zone 2 flexor tendon repair is sparse and conflicting. The purpose of this study is to assess the impact of digital nerve injury on the range of motion recovery after zone 2 flexor tendon repair. We hypothesized that digital nerve injury is independently associated with decreased motion after zone 2 flexor digitorum profundus (FDP) repair. Methods This is a single-institution, multisurgeon retrospective analysis of patients treated with primary zone 2 FDP repair. Patients with or without digital nerve injuries were included. Patients with fracture, extensor tendon injury, dysvascularity, follow-up duration of less than 10 weeks, and younger than 15 years were excluded. The primary outcome measure was Strickland percentage at the last therapy visit. Bivariate analysis was performed using simple linear regression. These results were used to guide backward stepwise multivariable analysis of qualifying exploratory variables. Results Forty-one patients with a total of 54 zone 2 FDP injuries qualified. Mean follow-up duration was 24 ± 10 weeks, and mean age was 38 ± 18 years. Thirty-three digits had a concomitant digital nerve injury, 26 digits had multidigit involvement, and 42 digits had combined FDP and flexor digitorum superficialis (FDS) injuries. Both older age and concomitant FDS injury exhibited independent relationships with poorer range of motion outcomes ( P < .05). Digital nerve injury, follow-up duration, gender, and multidigit involvement did not influence final digital motion. Conclusions In patients undergoing zone 2 FDP repair, concomitant digital nerve injury is not independently associated with poorer postoperative active range of motion.

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Section: Introductionmentioning

confidence: 99%

Does Digital Nerve Injury Affect Range of Motion Recovery After Zone 2 Flexor Tendon Repair?

Keane

Stonner

Pet

2021

Hand (New York, N,Y.)

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“…[ 15 ] On the other hand, there are studies reporting that there is no significant relationship between digital nerve injury and flexor tendon repair outcomes. [ 7 , 16 , 17 ] In these studies, digital nerve injury did not affect the TAM value in patients with flexor tendon repair, but this does not indicate that digital nerve repair is not required in these cases.…”

Section: Discussionmentioning

confidence: 75%

Is microsurgical experience essential in Zone II flexor tendon injuries?

Pamuk¹

2023

Jt Dis Relat Surg

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This study aims to investigate whether microsurgical experience was necessary for the treatment of Zone II flexor tendon injuries.Patients and methods: Between October 2018 and October 2021, a total of 73 Zone II flexor tendon injuries in 71 patients (53 males, 18 females; mean age: 39.6±12.1 years; range, 21 to 57 years) who underwent surgical intervention in our center were retrospectively analyzed. All patients in the study had flexor digitorum profundus (FDP) tendon injury. The clinical outcomes of patients with digital artery injury, nerve injury or phalanx fracture accompanying FDP tendon injury were evaluated separately according to the American Society for Surgery of the Hand (ASSH) scores. The scores of multiple injuries accompanying FDP tendon injury in patients with FDP+flexor digitorum superficialis (FDS)+digital nerve injury and FDP+FDS+digital artery+nerve injury were evaluated. Results:The mean ASSH score was 69.4±28.2 in the group with FDP tendon injury accompanying digital nerve injury and 62.9±19.7 in the group with FDP tendon injury and digital artery injury. The clinical outcomes were significantly lower in patients with digital nerve injury and digital artery injury respectively, compared to patients without accompanying injuries (p=0.029 and p=0.012, respectively). The lowest mean score (45.3±10.2) was in patients with fracture accompanying FDP tendon injury and ASSH score was significantly lower than in patients without fracture (p<0.001). Conclusion:Zone II flexor tendon injuries are frequently accompanied by digital artery or nerve injuries, which usually require microsurgical repair. If left untreated, treatment outcome may be poor. Surgical centers and departments undertaking the treatment of flexor tendon injuries should be able to perform microsurgery.

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“…Thus, after the repair of all FDP injuries under the loupes, anastomoses for injured NV structures were subsequently performed using microscopy. Concomitant digital nerve injuries have been known to have little associations with postoperative outcomes after the repair of flexors; however previous literature has reported outcomes focused on ROM 24–27 . Also, the studies did not differentiate between bilateral and unilateral nerve injuries.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Flexor Tendon Repair in Patients With Concurrent Neurovascular Injuries of Multiple Digits in Zone 1

et al. 2022

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PurposeWe treated several patients with multiple flexor (flexor digitorum profundus; FDP) injuries accompanied by injuries to the digital nerve or vessels around the distal interphalangeal crease (zone 1). Here, we retrospectively report the outcomes and review the literature.Materials and MethodsBetween January 2010 and December 2018, 16 patients who met the study inclusion criteria were investigated. Tendons were repaired using the cross-locked cruciate (Adelaide) technique (6-strand) or modified Becker method (4-strand). The neurovascular structures were repaired under a microscope.ResultsSixteen patients (47 digits) were treated. According to the criteria of Moiemen and Elliot, the lacerated areas were in zones IA and IB in 7 and 40 digits, respectively. The mean ranges of motion were 149.27 ± 7.78 and 66.43 ± 2.04 degrees according to the Strickland and modified Strickland assessments, respectively. The mean 2-point discrimination was 5.00 ± 0.63 mm. Four patients (group 1) presented with injuries to 2 digits, and 9 (group 2) and 3 (group 3) patients had 3 and 4 injured digits, respectively. The outcomes were satisfactory in terms of the mean range of motion; 2-point discrimination; cold tolerance; visual analog scale pain score; Disabilities of the Arm, Shoulder, and Hand score; and grip strength. There were no differences among the groups.ConclusionsOpen multiple-finger injuries involving flexor digitorum profundus rupture with concurrent neurovascular injuries on one or both sides occasionally occur in industrial environments. Fortunately, each digit exhibits a consistent injury type in a particular anatomical location; appropriate repair yields satisfactory outcomes despite the presence of multiple injuries.

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Prognostic factors for digital range of motion after intrasynovial flexor tendon injury and repair: Long-term follow-up on 273 patients treated with active extension-passive flexion with rubber bands

Cited by 14 publications

References 20 publications

Does Digital Nerve Injury Affect Range of Motion Recovery After Zone 2 Flexor Tendon Repair?

Does Digital Nerve Injury Affect Range of Motion Recovery After Zone 2 Flexor Tendon Repair?

Is microsurgical experience essential in Zone II flexor tendon injuries?

Outcomes of Flexor Tendon Repair in Patients With Concurrent Neurovascular Injuries of Multiple Digits in Zone 1

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