Background: Flexor tendon repair outcomes have improved with minimal touch technique, preservation of pulleys, multi-strand repair and early motion, but it remains a challenging condition to manage.
Aim: Review the impact of changes in training and supervision of flexor tendon repairs at Hutt Hospital implemented from 2013 by reviewing outcomes of all flexor tendon repairs distal to the A1 pulley at Hutt Hospital from 2011 to 2014. Outcomes at Regions Hospital in Minnesota, USA were compared as reference.
Results:
393 flexor tendons were repaired in 164 patients at Hutt Hospital. Between 2011 to 2012, the rupture rate at Hutt Hospital was 13% compared to 3% at Regions Hospital. It was noted at Hutt Hospital that rupture rates were higher if a single surgeon was operating especially on the thumb, ring or little finger.
Following this, our unit implemented a policy that the first ten flexor tendon repairs by a registrar be directly supervised by a consultant and that two surgeons be present for injuries to thumb, ring or little finger.
The rates of flexor tendon rupture at Hutt Hospital was significantly lower between 2013-2014 (4%, p=0.0008). 80% of patient with rupture proceeded to a staged secondary flexor tendon reconstruction.
Discussion:
Our study shows reductions in rupture post flexor tendon ruptures after changes in training and supervision were implemented.