The evolving practice of Flexor tendon management in a tertiary hand centre

We present a single tertiary referral centers experience of managing acute zone two flexor tendon injuries and how the implementation of four key strategies has improved patient outcomes.Methods We reviewed flexor tendon repairs from 1997 to 2009 and looked at the impact of Hand Therapist led clinics, consultant led trauma lists, training days and four strand core repairs with epitendinous suturing on outcomes of acute flexor tendon injury. Results In 1997 using two strand repairs and controlled active mobilization we demonstrated rupture rates of 30%. Hand therapist led clinics and Consultant led trauma lists were implemented in 2001. Audit of this implemented strategy showed rupture rates drop to 17%. In 2004 the evolving practice of two strand to four strand repairs showed a reduction in rupture rates from 20% to 6%. In 2005 the policy of four strand repairs for all patients was adopted along with the introduction of consultant led training days. In 2006, re-audit of tendon repairs demonstrated a 0% rupture rate and poor modified Strickland score in 24% of patients. Re-audit in 2009 shows rupture rates of 5% and a poor modified Strickland score in 42% of patients secondary to increased time waiting to surgery (mean 8.38 days versus 4.46 days). ConclusionWe have demonstrated that the implementation of four key strategies can have a significant impact on acute flexor tendon care, however prolonged time to surgery has a significant impact on functional outcome secondary to biological changes which are not yet understood.