Extensor Tendon Repair Outcomes Based on Zone of Injury

Abstract

Background: The purpose of this study was to examine the clinical outcomes of extensor tendon repairs based on zone of injury. Methods: A retrospective chart review was conducted on all patients who underwent primary extensor tendon repair at our institution. Extensor tendon repairs were performed using a multiple figure-of-8 suture technique for extensor zones 1-4 and a modified Kessler suture technique for extensor zones 5-8. Inclusion criteria included a minimum of 8 weeks of follow-up, complete data available for review, and extensor tendon injury requiring primary surgical repair. Results: A total of 132 digits were included for analysis: 46 digits in zones 1-4 and 86 digits in zones 5-8. The operative time for zone 1-4 injuries averaged 88.96 minutes, and the operative time for zone 5-8 injuries averaged 114.42 minutes. Final extension was found to be 2.33° for zones 1-4 and 6.66° for zones 5-8. Final flexion was found to be 141.4° for zones 1-4 and 195.3° for zones 5-8. There was 1 infection identified in zones 1-4 and 7 in zones 5-8. Conclusions: Surgically repaired extensor tendons in zones 1-4 were found to have a statistically significant worse final flexion compared with surgically repaired extensor tendons in zones 5-8. No significant differences were found in final extension, complication rates, and time to full activity. Operative times for zone 5-8 tendon repairs were found to be significantly longer than operative times for zone 1-4 repairs, possibly due to more complex injury patterns seen in the more proximal zones.

The Influence of Insurance Status on Extensor Tendon Repair Outcomes

“…Previous studies have identified that, although the zone of injury of an extensor tendon laceration undergoing primary repair does have an effect on overall outcomes [5], the timing of the surgical repair does not have a significant impact on overall functional recovery [6]. Although our cohort did not identify an increase in time from injury to surgery in uninsured patients compared those with insurance coverage, it is a logical assumption that uninsured patients may face increased time to surgical care if they are unaware of what community resources are available in their areas, as it has been well established that un-and under-insured patients face greater barriers to accessing hand surgery care than insured patients.…”

“…While these injuries are relatively common, if not treated appropriately, extensor tendon injuries can be a source of substantial morbidity, including stiffness and/or loss of function and dexterity [2,3]. There are many established prognostic factors predicting outcomes after extensor tendon repair, such as extensor tendon zone of injury [4,5], timing of surgery [6], mechanism of injury [7], timing of postoperative rehabilitation [3,4], rehabilitation protocols [7,8], and certain patient characteristics [7].…”