gms | German Medical Science

Objectives/Interrogation: Surgical repair of Zone 1 flexor tendon injuries is associated with significant complications depending on the fixation methods. Some studies have reported a complication rate as high as 65% and there is no consensus on optimal fixation technique. We report our results of treating Zone 1 FDP injuries at tertiary referral Hand Unit.

Methods: All Zone 1 FDP injuries between January 2012 to December 2017 were retrieved from our in-house bespoke electronic database, the eHands. Relevant patient demographics, mechanism of injury, type of injury classified according to Leddy and Packer classification, intra-operative findings, rehabilitation protocol and functional assessment as per modified Strickland criteria were recorded.

Results and Conclusions: A total of 68 Zone 1 FDP injuries with a mean follow-up of 72 months (range 9-56m) were included in the study. The average age of the patients was 21y (range 18-54), majority being men(n=41). Time from injury to surgery was at a mean of 5 days (range 3-8d). Contact sports were the major cause of the injury(n=21). Majority of the injuries were Leddy Parker type 2(n=18) and type 1(n=32). Only 3 patients had type 4 injury and the remaining patients has type 4 injury. A significant proportion of Zone 1 injuries were treated by Mitek micro bone anchor (DePuy Mitek Inc., MA, USA): n=48. All patients underwent rehabilitation as per the Belfast controlled active movement (CAM) regime. 6 patients underwent surgery for subsequent complications, two directly related to the failure of the bone anchor. According to the modified Strickland criteria 18 patients had excellent, 13 had fair and the remaining had poor outcome.

The current study is the largest series reporting the use of bone anchors in Zone 1 FDP tendon injuries. These injuries when treated with bone anchors although have a low complication rate, are not necessarily associated with excellent outcomes.