The Impairments and Functional Outcomes of Patients Post Flexor Tendon Repair of the Hand

Abstract

Backgrounds: Flexor tendon injuries are common hand injuries for which optimal surgical and postoperative treatment has not yet been established. The variability in results is great, with good outcomes being achieved in specialized hands units in developed countries. Minimal research has been undertaken in developing countries, in particular South Africa, regarding flexor tendon repair (FTR) and the outcomes thereof. Objectives: The purpose of this study was to establish the range of movement (ROM), grip strength, and hand function at 6 months post FTR as well as to determine the factors that affect the impairments and functional outcome at 6 months post FTR. Materials and Methods: The study was conducted at a tertiary hospital in South Africa. At 1, 3, and 6 months post FTR, the ROM of the injured and contralateral finger(s) were measured using a finger goniometer. The Total Active Motion (TAM) classification system was applied to each affected digit, and the average TAM was determined for the participants’ affected hand. At 3 and 6 months post FTR, the participants’ bilateral power and pinch grip strength were measured using a Jamar dynamometer and a pinch meter. The power and pinch grip strengths were calculated as a percentage of the unaffected hand. At 3 and 6 months post FTR, participants performed the Jebsen Hand Function Test (JHFT), and a Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire was administered in an interview format. Results: A total of 126 participants enrolled in the study. There was a dropout rate of 48%, leaving 65 participants who completed 6 months follow-up, 41 males (63%) and 24 females (37%) aged 32 years (SD ± 12, n = 65). Out of 65 participants, 2% (n = 1) had an excellent outcome, 32% (n = 21) had a good outcome, 32% (n = 21) had a fair outcome, and 34% (n = 22) had a poor outcome with regard to TAM. At 6 months post FTR, the average power grip was 60% (SD ± 25, n = 65) of the unaffected hand while the average pinch grip was 52% (SD ± 42, n = 65) of the unaffected hand. The average score on the QuickDASH questionnaire was 19.34 (SD ± 16.89) at 6 months. Of the 41 participants who were employed prior to injury, 71% (n = 29) had returned to work by 6 months post surgery and scored an average of 15.89 (SD ± 23.74) on the QuickDASH work module. Sixty-eight percent (n = 44) of the patients had postoperative complications: the most common complication was tenodesis/adhesions (25%, n = 16), followed by contracture (22%, n = 14). There were only 4 ruptures (6%, n = 4) in this sample. Eleven participants (17%) underwent further surgery. The factors that affect the impairments and functional outcome at 6 months post FTR include age, zone of injury, number of digits injured, associated injury, delay between injury and surgery, and language barrier. Conclusion: Although there were some promising outcomes, during this period, participants did not consistently achieve the good or excellent functional outcomes achieved in developed countries. More research needs to be conducted regarding the outcome of FTR in South Africa, particularly in the public sector.