Abstract
Introduction/Aim
Flexor tendon injuries of the hand are common with an incidence of over 3000 per annum in the UK. These injuries can affect hand function significantly. Early treatment with optimal repair is crucial to prevent disability.
This study aimed at investigating the re-rupture rate following primary flexor tendon repair at our institution and to identify potential risk factors for re-rupture.
Methods
100 flexor tendons' injuries that underwent primary repair over a one-year period were reviewed retrospectively.
Data was collected on age, gender, occupation, co morbidities, injured fingers, hand dominance, smoking status, zone of injury, time to surgery, surgeon grade, type of repair and suture, and antibiotic use on included patients. Causes of re-rupture were examined. We compared primary tendon repairs that had a re-rupture to those that did not re-rupture. Univariate and multivariate analysis was undertaken to identify the most significant risk factors for re-rupture.
Results
11 out of 100 (11%) repaired tendons went on to re-rupture. A significantly higher proportion of tendons re-rupture was noted when the repair was performed on the dominant hand (p-value = 0.009), in Zone 2 (0.001), and when a surgical delay of more than 72 hours from the time of injury occurred (0.01). Multivariate regression analysis identified repairs in Zone 2 to be the most significant predictor of re-rupture.
Causes of re-rupture included infection in 5, rupture during rehabilitation exercises in 5 and fall in 1 patient.
Conclusions
A re-rupture rate of 11% was noted in our study. Patients with Zone 2 injuries, repair on dominant hand and those with a surgical delay of more than 3 days were at higher risk of re-rupture. Careful consideration of these factors especially zone 2 injuries is crucial to reduce this rate. Providing a fast-track pathway for managing these patients can reduce time to surgery.
