Functional outcome and medicolegal implications of flexor tendon injuries at the wrist

Abstract EN

Background : Flexor tendon injuries at the wrist (zone V) are commonly associated with significant morbidity.

Suboptimal recovery leads to residual disability with serious medico legal impacts.

Objective : To investigate the factors influencing the functional outcome of zone V flexor tendon injuries and their medico legal aspects.

Methodology : Twenty patients with surgically repaired zone V flexor tendon injuries were included in the study.

For each patient, flexion and extension composite range of motion of the digits as well as grip and pinch strengths were assessed before and after a supervised rehabilitation program.

Data considering the place where injury took place, causative agent, time of surgery and postoperative complications and time of start of postoperative rehabilitation were recorded.

Ultrasonographic evaluation was used to evaluate the status of tendon recovery at the end of the rehabilitation program.

Results : Based on assessment of digital range of motion deficit and occupation handicap, the study showed that 40% of patients recovered with less than 20% range of motion deficit, and could resume their pre-injury working ability.

Sixty percent of the studied patients ended their rehabilitation program with 20% or more loss of digital range of motion with difficulty in resuming their pre-injury working abilities.

The extent of tendon injury, associated nerve involvement, delay of postoperative rehabilitation and the initial base line assessment have shown significant negative correlation with the outcome measures.

Multiple linear regression analysis showed that those variables were significant predictors of the final outcome measures.

Ultrasound assessment revealed complete tendon healing in 40% of patients.

Tendon adhesions, deficient healing and swellings indicative of infection or hematomas were demonstrated in 60% of the studied patients.

Conclusion and Recommendations : It is recommended that structured supervised postoperative rehabilitation should be started promptly early postoperatively and that every effort is to be made to avoid postoperative complications.

Predictors of final outcome may be used to plan and modify the program to ensure best results.

Evaluation of patients’ disability should be accomplished in the context of their jobs and social tasks.

Determination of responsibility for settlement of compensation should consider all factors contributing to the final disability.