Neglected tendon and nerve injuries of the hand

Abstract

We retrospectively reviewed 445 patients with neglected tendon and nerve injuries treated between 1983 and 2003. Of these patients, 355 patients (447 tendons) had flexor tendon injuries, 62 patients (84 tendons) had extensor tendon injuries, and 28 patients had isolated nerve injuries. (In addition to these, 48 patients had nerve injuries associated with flexor tendon injuries; making a total of 76 patients with nerve injuries.) Most of the patients presented for treatment from 2 months to 2 years after the injury. The majority (73%) of patients with flexor tendon injuries were treated by free tendon grafting. Sixty-two patients required staged reconstruction using a silicon implant. The followup ranged from 12 to 83 months (mean, 45.8 months). In flexor tendon injuries, overall excellent results were seen in 83 of 447 tendons (18.5%) and good results were seen in 70.5%. In extensor tendon injuries, 23% had excellent results, 53% had good results, 34% had poor results. Seventy-six patients (114 nerves) of neglected nerve injuries of the hand were treated during the same period. In 48 (63%) patients the nerve injury was associated with tendon injury. End-to-end repair was possible in 89 nerves and the remainder was grafted. Because nerves in the hand have a predominant sensory component, sensory recovery was seen in the majority of patients.