European Journal of Cardiovascular Medicine

Hand injuries constitute a significant proportion of trauma cases presenting to emergency departments and orthopedic or plastic surgery units worldwide. Due to the intricate anatomy of the hand and its essential role in daily activities, even minor injuries can lead to substantial functional impairment if not managed appropriately. Tendon injuries of the hand, particularly involving flexor and extensor tendons, are common following sharp or crush trauma and pose considerable challenges in terms of surgical repair and postoperative rehabilitation. Restoration of hand function after tendon repair remains a critical determinant of patient quality of life, work productivity, and social independence.^[1][2]

Tendons play a vital role in transmitting muscular forces to bones, enabling coordinated movement and fine motor control. Injury to these structures disrupts the biomechanical balance of the hand, resulting in loss of strength, dexterity, and range of motion. Despite advances in microsurgical techniques and suture materials, outcomes following tendon repair are influenced by multiple factors, including the zone of injury, timing of repair, surgical technique, postoperative immobilization, and adherence to rehabilitation protocols. Complications such as tendon adhesions, rupture, joint stiffness, and infection can adversely affect functional recovery.^[3]

Functional outcome assessment following tendon repair has gained increasing importance, shifting the focus from mere anatomical healing to restoration of meaningful hand function. Objective measures such as range of motion, grip strength, and standardized functional scoring systems provide valuable insights into postoperative recovery. Cross-sectional evaluation of these outcomes allows for the assessment of functional status at a specific point in time and helps identify determinants of good or poor recovery. Such analyses are particularly relevant in tertiary care settings, where patients often present with varied injury patterns and delayed treatment.^[4]

AIM

To evaluate functional outcomes after tendon repair in patients with hand injuries.

OBJECTIVES

1. To assess functional recovery of the hand following tendon repair using standardized outcome measures.
2. To analyze the association between injury characteristics and postoperative functional outcomes.
3. To evaluate the impact of surgical repair and rehabilitation on hand function.

Source of Data Data were obtained from patients presenting with hand tendon injuries who underwent tendon repair and follow-up at the study center during the study period. Study Design A hospital-based cross-sectional analytical study was conducted. Study Location The study was carried out at a Department of Plastic Surgery, Tirunelveli Medical College. Study Duration The study was conducted from July 2023 to June 2024 Sample Size A total of 200 patients who fulfilled the eligibility criteria were included in the study. Inclusion Criteria • Patients aged ≥18 years. • Patients with traumatic hand injuries involving flexor or extensor tendon rupture. • Patients who underwent primary tendon repair. • Patients available for functional assessment during follow-up. • Patients who provided informed consent. Exclusion Criteria • Patients with associated fractures affecting hand function. • Patients with neurovascular injuries causing permanent neurological deficits. • Patients with previous hand deformities or prior tendon injuries. • Patients with incomplete medical records or lost to follow-up. • Patients with systemic conditions affecting wound healing (e.g., uncontrolled diabetes). Procedure and Methodology All eligible patients underwent tendon repair as per standard surgical protocols. Surgical details including type of tendon injured, zone of injury, and repair technique were recorded. Postoperative immobilization and rehabilitation protocols were standardized as per institutional guidelines. Functional assessment was performed at follow-up using validated hand function scoring systems and range-of-motion measurements. Sample Processing Collected data were entered into a structured proforma and subsequently coded and entered into a digital database for analysis. Data accuracy was verified by cross-checking medical records. Statistical Methods Data were analyzed using appropriate statistical software. Quantitative variables were expressed as mean ± standard deviation, and qualitative variables as frequency and percentage. Associations between variables were analyzed using chi-square test, t-test, or appropriate non-parametric tests. A p-value <0.05 was considered statistically significant. Data Collection Data collection included demographic details, injury characteristics, surgical details, rehabilitation compliance, and functional outcome scores. All information was collected prospectively from patient records and direct assessment during follow-up visits.

Table 1: Baseline Clinicodemographic Profile and Overall Functional Outcome (N = 200)

Table 1 summarizes the baseline clinicodemographic characteristics and overall functional outcomes of the 200 patients included in the study. The mean age of the study population was 36.8 ± 11.3 years, indicating that tendon injuries predominantly affected young and middle-aged adults. A clear male predominance was observed, with males constituting 71.0% of the cases, which was statistically significant (χ² = 4.21, p = 0.040), suggesting a higher risk or exposure among males. Injury to the dominant hand was noted in 59.0% of patients and was also significantly associated with functional outcomes (p = 0.049).

Flexor tendon injuries were more common than extensor tendon injuries, accounting for 62.0% of cases. The predominance of flexor tendon involvement showed a statistically significant association with outcomes (p = 0.013), reflecting the complex anatomy and functional importance of flexor tendons. The mean time to surgery was 18.6 ± 7.9 hours, and earlier surgical intervention was associated with significantly better functional results (p < 0.001). The final mean DASH score was 28.4 ± 12.7, indicating moderate residual disability. Overall, 68.0% of patients achieved a good to excellent functional outcome, which was statistically significant (p = 0.005), highlighting favorable results following tendon repair.

Table 2: Functional Recovery Using Standardized Outcome Measures (N = 200)

Table 2 presents the assessment of functional recovery using standardized outcome measures. The mean total active motion achieved by patients was 214.6 ± 32.9 degrees, reflecting satisfactory restoration of finger mobility following tendon repair. Grip strength recovery averaged 76.3 ± 13.1% of the normal contralateral hand, which was statistically significant (p < 0.001), indicating meaningful functional improvement.

The mean DASH score remained 28.4 ± 12.7, consistent with moderate functional limitation but acceptable recovery in most patients. According to the Strickland scoring system, excellent and good outcomes were observed in 32.0% and 36.0% of patients respectively, while fair and poor outcomes accounted for 22.0% and 10.0%. The distribution of Strickland scores was statistically significant (p < 0.001), emphasizing the effectiveness of surgical repair and rehabilitation. The mean time taken to return to work was 7.6 ± 2.4 weeks, and earlier return to work showed significant association with better functional recovery (p < 0.001).

Table 3: Association Between Injury Characteristics and Functional Outcome (N = 200)

Table 3 analyzes the association between injury characteristics and postoperative functional outcomes. Among patients with good to excellent outcomes, 70.6% sustained flexor tendon injuries, compared to 43.8% in the fair-poor outcome group. This difference was statistically significant (p < 0.001), indicating a strong association between tendon type and outcome.

Zone II injuries were significantly more frequent in patients with fair-poor outcomes (64.1%) than in those with good-excellent outcomes (42.6%) (p = 0.005), highlighting the challenging nature of repairs in this zone. Clean-cut injuries were strongly associated with favorable outcomes, whereas crush injuries were significantly associated with poor functional recovery (p < 0.001). Early surgical repair within 24 hours was one of the strongest predictors of good outcome, with 76.5% of early-repaired cases achieving good-excellent results compared to only 34.4% in delayed repairs (p < 0.001).

Table 4: Impact of Surgical Repair and Rehabilitation on Hand Function (N = 200)

Table 4 evaluates the effect of rehabilitation adherence on functional outcomes. Patients who adhered to structured rehabilitation protocols demonstrated significantly better outcomes across all functional parameters. The mean final DASH score in the adherent rehabilitation group was 22.6 ± 9.8, compared to 39.1 ± 13.6 in the poor adherence group, showing a highly significant difference (p < 0.001).

Similarly, total active motion and grip strength were significantly higher in patients who complied with rehabilitation protocols (p < 0.001). Tendon rupture was observed in only 3.1% of patients in the adherent group compared to 15.3% in the poor rehabilitation group (p = 0.002), indicating a protective effect of proper physiotherapy. Overall, 81.3% of patients in the adherent group achieved good-excellent outcomes, compared to 44.4% in the poor adherence group, demonstrating a strong and statistically significant impact of rehabilitation on hand function (p < 0.001).

Baseline Clinicodemographic Profile and Overall Functional Outcome (Table 1): In the present study, the mean age of patients was 36.8 ± 11.3 years, indicating that tendon injuries of the hand predominantly affected young and economically productive individuals. This finding is consistent with reports by Bennett DJ et al. (2023)^[5], who observed a higher incidence of hand tendon injuries in the third and fourth decades of life, largely attributable to occupational and accidental trauma. The significant male predominance (71.0%) noted in our study aligns with previous literature, where males accounted for 65–80% of cases, reflecting higher exposure to manual labor and industrial injuries.

Injury to the dominant hand was observed in 59.0% of patients and showed a statistically significant association with functional outcomes. Similar findings have been reported by Shaw AV et al. (2022)^[4], who emphasized that dominant hand injuries often motivate better rehabilitation compliance but may initially present with greater functional impairment. Flexor tendon injuries constituted the majority (62.0%) of cases, a distribution comparable to studies by Janakiramanan N et al. (2021)^[6], where flexor injuries were more frequent and functionally more demanding than extensor injuries.

The mean time to surgery was 18.6 ± 7.9 hours, and early intervention showed a strong association with improved outcomes. This corroborates evidence from Lalchandani GR et al. (2022)^[2], who demonstrated that early tendon repair significantly reduces adhesion formation and improves range of motion. The overall good–excellent outcome rate of 68.0% in our study is comparable to previously reported success rates ranging from 60% to 75%, confirming the effectiveness of timely surgical repair and structured postoperative care.

Functional Recovery Using Standardized Outcome Measures (Table 2): Functional recovery assessed using standardized outcome measures demonstrated satisfactory results. The mean total active motion (214.6 ± 32.9 degrees) achieved in this study is comparable to outcomes reported by Lalchandani GR et al. (2022)^[2], where mean TAM values ranged between 200 and 230 degrees following primary tendon repair. Grip strength recovery to 76.3% of the contralateral side reflects meaningful functional improvement and is consistent with findings by Huynh MN et al. (2022)^[7].

The mean DASH score of 28.4 ± 12.7 observed in our cohort indicates moderate residual disability, which is similar to scores reported in comparable studies conducted in tertiary care settings. According to the Strickland scoring system, 68.0% of patients achieved good to excellent outcomes, closely matching the results reported by Shaw AV et al. (2022)^[4]. The mean return-to-work time of 7.6 ± 2.4 weeks is also in agreement with earlier studies, emphasizing the socioeconomic benefit of successful tendon repair and rehabilitation.

Association Between Injury Characteristics and Functional Outcome (Table 3): Analysis of injury characteristics revealed several significant predictors of functional outcome. Flexor tendon injuries were more frequently associated with good–excellent outcomes in our study, which may reflect advances in surgical techniques and rehabilitation protocols, as also suggested by Lalchandani GR et al. (2022)^[2]. Zone II injuries, however, were significantly associated with poorer outcomes, consistent with the classical concept of “no man’s land” described in earlier literature.

Clean-cut injuries showed a strong association with favorable outcomes, while crush injuries were linked to poor recovery. Similar observations were made by Jia Q et al. (2023)^[1], who reported that tissue damage severity significantly influences tendon healing and functional restoration. Early repair within 24 hours emerged as the strongest predictor of good outcome in our study, reinforcing the importance of prompt surgical intervention, as supported by multiple previous studies.

Impact of Surgical Repair and Rehabilitation on Hand Function (Table 4): The impact of rehabilitation adherence on functional outcomes was profound in this study. Patients who adhered to structured rehabilitation protocols demonstrated significantly better DASH scores, greater total active motion, and higher grip strength. These findings strongly support earlier work by Stonner MM et al. (2022)^[8] & Uçkun AÇ et al. (2020)^[9], who emphasized that rehabilitation compliance is as critical as surgical technique in determining final outcomes.

The significantly lower tendon rupture rate in the adherent rehabilitation group (3.1% vs 15.3%) mirrors results reported by Fridén J et al. (2022)^[10], highlighting the protective role of supervised physiotherapy. Furthermore, the markedly higher proportion of good–excellent outcomes in the adherent group underscores the necessity of patient education and access to rehabilitation services, particularly in resource-limited settings.

This cross-sectional analysis demonstrates that satisfactory functional recovery can be achieved following tendon repair in hand injuries when timely surgical intervention and structured rehabilitation protocols are implemented. The majority of patients in the present study were young, economically active males, highlighting the significant occupational and socioeconomic impact of hand tendon injuries. A substantial proportion of patients achieved good to excellent functional outcomes, as reflected by favorable DASH scores, adequate total active motion, and acceptable grip strength recovery. Early surgical repair, clean-cut injury patterns, and adherence to postoperative rehabilitation emerged as key determinants of successful functional recovery. Conversely, delayed presentation, crush injuries, and Zone II tendon involvement were associated with poorer outcomes. The study also reinforces the critical role of rehabilitation compliance, as patients adhering to physiotherapy protocols demonstrated significantly better functional parameters and lower complication rates, including tendon rupture. Overall, the findings emphasize that optimal functional outcomes after tendon repair depend not only on surgical expertise but also on early intervention, injury characteristics, and sustained rehabilitation efforts. These results underscore the need for patient education, early referral, and standardized postoperative rehabilitation programs to minimize disability and enhance hand function following tendon injuries. LIMITATIONS OF THE STUDY 1. The cross-sectional study design limits the ability to establish causal relationships between variables and functional outcomes. 2. Functional assessment was performed at a single follow-up point, which may not reflect long-term recovery or late complications. 3. The study was conducted at a single tertiary care center, limiting the generalizability of results to other healthcare settings. 4. Variations in patient compliance with rehabilitation protocols could not be objectively quantified. 5. Occupational demands and psychosocial factors influencing functional recovery were not assessed. 6. Advanced imaging and biomechanical assessments were not included for objective tendon healing evaluation.

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