gms | German Medical Science

Objectives/Interrogation: We compared the outcomes of delayed zone 2 flexor tendon repairs by surgeons with less fatigue and better assistants with those patients repaired in emergency settings in late afternoon or night when surgeons have remarkable fatigue and less qualified assistants.

Methods: We repaired 83 flexor digitorum profundus (FDP) tendons in zone 2 of 68 patients from November 2013 to July 2017. There are 54 men and 14 women. The average age of patients was 36 (range 17 to 65) years old. 36 fingers were repaired after a delay a mean of 4 (2 to 10) days with primary skin closure and later tendon repair. 47 fingers were repaired primarily with 12 hours after injury. The FDP tendon was repaired with the 6-strand M-Tang repair using 4-0 looped suture and sparsely placed simple running peripheral suture with 6-0 or 5-0 nylon. The delayed repair was performed in the daytime with better assistants (1 or 2 junior attending surgeons or residents) and the primary repair was performed during the late afternoon or nighttime with only one general surgery resident to assist. After surgery, the fingers in both groups of patient followed the same rehabilitation protocols of early active motion, with partial range digital active flexion in the first 3-4 weeks and full range of active flexion thereafter. We compared the functional results and demographics and injury factors (gender, age, accompanied injuries, and follow-up lengths) between patients treated with delayed repair or repair in emergency settings.

Results and Conclusions: There are 25 excellent, 7 good, 3 fair, 1 poor in the fingers with delayed primary, and 23 excellent, 13 good, 8 fair, 3 poor outcomes using primary repair with follow-up of 8 to 27 months. There were no tendon ruptures. The mean range of motion of the proximal and distal interphalangeal joints in the 36 fingers with delayed primary repair was 161+/-25 degrees, which significantly better than that of 47 fingers with primary repair of 147 +/- 29 degrees (p = 0.018). We found no significant differences in demographics and injury factors (gender, age, accompanied injuries and follow-up lengths) between the two groups.

A primary repair in the late afternoon or nighttime with inexperienced assistants has worse outcomes than delayed primary repair as a selective procedure with experienced assistants. We conclude that surgeons' fatigue and quality of assistants affect outcomes of zone 2 flexor tendon repair.