FREQUENCY, DISTRIBUTION AND TREATMENT OF ACUTE FLEXOR TENDON INJURIES IN ZONE V OF HAND

Muhammad Shafiq

doi:10.46903/gjms/17.01.1857

FREQUENCY, DISTRIBUTION AND TREATMENT OF ACUTE FLEXOR TENDON INJURIES IN ZONE V OF HAND

Muhammad Shafiq

Abstract

Background: Flexor tendons injuries are common emergency procedures The objectives of this study were to determine the frequency, distribution and results of treatment of acute flexor tendon injuries in zone V of hand in our population.

Material and Methods: This descriptive cross-sectional was conducted in the Department of Orthopedic, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2017. Sample size was 30, selected through consecutive technique. Patients having flexor tendon injuries in zone v, admitted through emergency department were included in this study. Demographic variable were sex and age-groups. The research variable were tendon involved, nerves involved, artery involved, mechanism of injury, wound size, duration of injury, season, type of injury, hand involved and results of treatment. All variables, being categorical were analyzed by frequency and percentages using SPSS version 16.0.

Results: Out of 30 patients, 22(73.33%) were male. Twenty four (80%) patients were between 21 to 40 years age. Mechanism of injury was glass in 16(53.33%) cases, knife in 10(33.33%) cases. Twenty (66.66%) cases presented in summer. Flexor digitorum sublimus was injured in 21(70.0%), FCR in 11(36.66%), FPL in 8(26.66), FDP in 6(20.0%) and FCU in 4(13.33%) cases. Median nerve was involved in nine (30%) cases. Radial artery was involved in eight (26.66%) cases. Wound size was 2 cm in 24(80%) cases. Sixteen (53.33 %) cases came with self-inflicted injuries. Twenty (66.66 %) cases came after 12 hours. Twenty five (83.33%) patients achieved good to excellent results.

Conclusion: Flexor digitorus sublimus was the most common tendon injured in non-dominant hand, especially in young males. Median nerve and radial artery were commonly injured structures mostly with glass. Majority patients presented more than 12 hours after injury, having wound size of 2cm. Mostly the injuries were self-inflicted and occurred in summer season.

Keywords

Flexor tendon; Self-inflicted injury; Zone V injuries; Radial artery; Median nerve.

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References

Wee S K, Martin F L. Improving outcome in tendon repair. A critical look at the evidence for flexor tendon repair and rehabilitation. Plast Reconstr Surg 2016;138(6):1045-58. https://doi.org/10.1097/PRS.0000000000002769

Canale ST, Beaty J. Flexor and extensor tendon injuries. Campbell’s Operative Orthopedics.12th ed. Amsterdam: Elsevier; 2013;pp.3247-99. https://doi.org/10.1016/B978-0-323-07243-4.00066-9

Mehdi Nasab SA, Sarrafan N, Saeidian SR, Emami H. Functional outcomes of flexor tendon repair of the hand at zone 5 and post-operative early mobilization of fingers. Pak J Med Sci 2013;29(1):43-6. https://doi.org/10.12669/pjms.291.2563

Isabella MH, Annika AW. Evidence based flexor tendon repair. Clin Plast Surg 2014;41(3):513-23. https://doi.org/10.1016/j.cps.2014.03.009

Jin B T .Wide Awake primary flexor tendon repair, tenolysis and tendon transfer. Clinic in Orthop Surg 2015;7(3):275-81. https://doi.org/10.4055/cios.2015.7.3.275

Maki Y. Primary flexor tendon repair and early mobilization. Hand Surg. 2014;19(3):327-8. https://doi.org/10.1142/S0218810414400024

Rigo IZ ,Rokkum M. Predictor of outcome after primary flexor tendon repair in zone 1,2 & 3. J Hand Surg Eur 2016;41(8):793-801. https://doi.org/10.1177/1753193416657758

Buck-Gramcko D. A new method for evaluation of results in flexor tendon repair. Handchirurgie 1976;8(2):65-9.

Cigdem B, Ozlem EI, Elif A. Functional outcome in patients with zone 5 flexor tendon injuries. Arch Orthop Trauma Surg 2005;125:405-9. https://doi.org/10.1007/s00402-005-0815-5

Wolfe S, Pederson W, Kozin SH, Cohen M. Flexor tendon injury, Green Operative Hand Surg. 7th ed. Amsterdam: Elsevier;2017:pp.183-230.

Rigo IZ, Hangstved JR, Rokkum M. The effect of adding active flexion to modified Kleinert regime on outcomes for zone 1 to 3 flexor tendon repairs. A prospective randomized trial. J Hand Surg Eur 2017 Nov;42(9):920-9. https://doi.org/10.1177/1753193417728406

Wilhelmi BJ, Kang RH, Wages DJ, Lee WP, May JW. Optimizing independent finger flextion with zone 5 flexor repairs using Massachusetts General Hospital flexor tenorrhaphy and early protected active motion. J Hand Surg Am 2005;30(20):230-6. https://doi.org/10.1016/j.jhsa.2004.07.009

Stefanich RJ,Putnam MD, Premier CA, Sherwin FS. Flexor tendon laceration in zone 5. J Hand Surg Am 1992;17(2):284-91. https://doi.org/10.1016/0363-5023(92)90407-G

Howell JW, Peck F. Rehabilitation of flexor and extensor tendon injuries in the hand :current updates. Injury 2013;44(3):397-402. https://doi.org/10.1016/j.injury.2013.01.022

Hudson DA, Dejager LT, The spaghetti wrirt: Simultanous laceration of median and ulnar nerve with flexor tendons at the wrist. J Hand Surg Br 1993;18(2):171-3. https://doi.org/10.1016/0266-7681(93)90098-Z

Ahmad M, Hussain SS, Tariq F, Rafiq Z, Khan MI, Malik SA. Flexor tendon injuries of hand: Experience at Pakistan Institute of Medical Sciences, Islamabad, Pakistan. J Ayub Med Coll Abbottabad 2007;19(1):6-9.

Incel NA, Ceceli E, Durnkan PB, Eedem HR, Yorganciogln ZR. Grip strength: effect of hand dominance. Singapoore Med J 2002;43(5):234-7.

Rouhani A, Tabrizi A, Ghavidel E. Effects of nonsteroidal anti inflammatory drugs on flexor tendon rehabilitation after repair. Arch Bone Jt Surg 2013 Sep;1(1):28-30.

Cutler GJ, Flood A, Dreyfus J, Henry WO, Kharbanda AB. Emergency department visit for self-inflicted injuries in adolescents. Pediatrics July 2015;136(1). https://doi.org/10.1542/peds.2014-3573

Chou CY, Chang HA, Chiao HY, Wang CY. Interchangable skin grafting to camouflage self inflicted wound scars on the dorsal and volar forearm, a case report. Ostomy Wound Manage 2014;61(4):50-2.

DOI: https://doi.org/10.46903/gjms/17.01.1857