Artikel
A multicenter observational study of clinical practice variation in the management of open flexor tendon injuries of the hand
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Veröffentlicht: | 10. Oktober 2017 |
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Objectives: Flexor tendon injuries are common and technically challenging injuries to treat. Anecdotally, there is significant clinical variability around the acute management and rehabilitation of these injuries.
Little is known regarding the current epidemiology, management, and outcome of open flexor tendon injuries in the UK. This multicentre prospective study aimed to define the incidence and current practice in managing these injuries to enable the development of national standards of care in hand trauma.
Method: All hand surgery units in the UK were invited to participate through the Reconstructive Surgical Trials Network and the British Society for Surgery of the Hand. All adult patients presenting with an open flexor tendon injury between July and September 2015 were included. Patients were followed up for 3 months. Data collected included; timings of review, operation, and rehabilitation; technical aspects of tendon repair; rehabilitation and outcome.
Results: 100 plastic and orthopaedic surgery collaborators at 38 hand surgical centres contributed a total of 874 flexor tendon injuries in 600 patients to the study. 82 patients (13.7%) presented with more than two tendons injured. 56% were flexor zone 2 injuries.
433 (72.7%) cases were reviewed by a hand surgical team within 24 hours of injury. 91.4% of injured tendons were repaired. 59.5% underwent surgery within 48 hours of the surgical review. The operating surgeon was a senior trainee or consultant surgeon in 61% of cases. Surgical repair was a four strand core suture in 72.5%, the most common repair techniques were; Modified Kessler 237 (39.5%), and Cruciate repairs 136 (22.7%), with a simple continuous epitendinous repair. Prophylactic antibiotics were prescribed in 472 (78.7%) of cases. 142 (23.7%) patients were reviewed by a hand therapist within 48 hours of surgery. 18% had a formal therapy assessment at 3 months post repair. The overall complication rate was 13.2%. Stiffness was reported in 13 cases (2.2%), tendon rupture rate was 3.7% (22), and 18 (3%) experienced a soft tissue infection.
Conclusion: This is the first UK national prospective multicentre hand study using a collaborative approach. We have identified significant variation in the delivery of hand trauma care. These data will inform future research and set a benchmark for future assessment of patient care following the introduction of national guidelines.