Top

Archives of Orthopaedic and Trauma Surgery

Published in:

10-11-2023 | Extensor Tendon | Handsurgery

Safety of immediate open traumatic extensor tendon repair performed at an emergency department minor procedure room

Authors: Tal Frenkel Rutenberg, Elkin Leon Galvis, Oren Michaeli, Tuna Ozyurekoglu

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2024

Abstract

Introduction

The superficial location of the extensor tendons makes them particularly vulnerable to lacerations. Patients most commonly present to the emergency department (ED) after these injuries. We aimed to measure the safety of immediate surgical repair of traumatic open extensor tendon injuries in an ED minor procedure room (MPR) under local anesthesia, and the associated post-operative infection and complication rates.

Materials and methods

We retrospectively evaluated all patients undergoing traumatic open extensor tendon repairs in the ED MPR over a 3.75-years period. Data collected included demographic information, comorbidities, mechanism of injury, additional procedures performed, and post-operative complications. All patients were operated under local anesthesia by a hand surgery fellow aided by an ED technician.

Results

Two hundred and forty eight patients (278 tendons) were treated for extensor tendon injuries during the study period. 220 patients (245 tendons) have complied with follow-up. No intra-procedural medical complications were encountered. The post-operative infection rate was 1.4%. The rate of other post-operative complications was not related to the number of tendons repaired, additional digit involvement, or if the nature of the injury was work-related.

Conclusions

In this cohort, traumatic extensor tendon repairs performed in an ED MPR were found to be medically safe and to associate with a low postoperative infection rate. As preoperative assessment is simple and practical, and limited medical personnel is utilized, this surgical setting may enable us to reduce medical costs.

de Jong JP, Nguyen JT, Sonnema AJM et al (2014) The incidence of acute traumatic tendon injuries in the hand and wrist: a 10-year population-based study. Clin Orthop Surg 6:196–202. https://doi.org/10.4055/cios.2014.6.2.196CrossRefPubMedCentral

Patillo D, Rayan GM (2012) Open extensor tendon injuries: an epidemiologic study. Hand Surg Int J Devot Hand Up Limb Surg Relat Res J Asia-Pacific Fed Soc Surg Hand 17:37–42. https://doi.org/10.1142/S0218810412500062CrossRef

Amirtharajah M, Lattanza L (2015) Open extensor tendon injuries. J Hand Surg Am 40:391–397. https://doi.org/10.1016/j.jhsa.2014.06.136. (quiz 398)CrossRef

Stephens AR, Presson AP, Jo YJ et al (2021) Evaluating the safety of the hand surgery procedure room: a single-center cohort of 1,404 surgical encounters. J Hand Surg Am 46:623.e1-623.e9. https://doi.org/10.1016/j.jhsa.2020.11.018CrossRefPubMed

Kazmers NH, Peacock K, Nickel KB et al (2021) Comparison of complication risk following trigger digit release performed in the office versus the operating room: a population-based assessment. J Hand Surg Am 46:877-887.e3. https://doi.org/10.1016/j.jhsa.2021.05.010CrossRefPubMedPubMedCentral

Avoricani A, Dar Q-A, Levy KH et al (2022) WALANT hand and upper extremity procedures performed with minor field sterility are associated with low infection rates. Plast Surg (Oakville, Ont) 30:122–129. https://doi.org/10.1177/22925503211003840CrossRef

Look N, Lalka A, Korrell H et al (2021) Outcomes of orthopedic hand surgeries in minor procedure rooms at a veterans affairs medical center. J Hand Surg Glob Online 3:7–11. https://doi.org/10.1016/j.jhsg.2020.10.007CrossRefPubMed

Stephens AR, Tyser AR, Presson AP et al (2021) A comparison of open carpal tunnel release outcomes between procedure room and operating room settings. J Hand Surg Glob Online 3:12–16. https://doi.org/10.1016/j.jhsg.2020.10.009CrossRef

Leblanc MR, Lalonde DH, Thoma A et al (2011) Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery. Hand (N Y) 6:60–63. https://doi.org/10.1007/s11552-010-9301-9CrossRefPubMed

10.

Newport ML, Blair WF, Steyers CM (1990) Long-term results of extensor tendon repair. J Hand Surg Am 15:961–966. https://doi.org/10.1016/0363-5023(90)90024-LCrossRefPubMed

11.

Aydin N, Uraloğlu M, Burhanoğlu ADY, Sensöz Ö (2010) A prospective trial on the use of antibiotics in hand surgery. Plast Reconstr Surg 126:1617–1623. https://doi.org/10.1097/PRS.0b013e3181ef90cbCrossRefPubMed

12.

Reynolds M, Srinivasan RC, Person DW (2022) Complications after clinic-based wide awake local anesthesia no tourniquet hand surgery at a single private practice. Hand (N Y) 17:865–868. https://doi.org/10.1177/1558944720975132CrossRefPubMed

13.

Dalton SS, Maharjan LM, Yousuf H, Pientka WF 2nd (2023) Extensor tendon repair outcomes based on zone of injury. Hand (N Y). https://doi.org/10.1177/15589447221150510CrossRefPubMed

14.

Davison PG, Cobb T, Lalonde DH (2013) The patient’s perspective on carpal tunnel surgery related to the type of anesthesia: a prospective cohort study. Hand (N Y) 8:47–53. https://doi.org/10.1007/s11552-012-9474-5CrossRefPubMed

15.

Alter TH, Warrender WJ, Liss FE, Ilyas AM (2018) A cost analysis of carpal tunnel release surgery performed wide awake versus under sedation. Plast Reconstr Surg 142:1532–1538. https://doi.org/10.1097/PRS.0000000000004983CrossRefPubMed

16.

Van Royen K, Ozyurekoglu T, Lozano-Garza CA, Graham D (2021) Hypodermic needle fixation without fluoroscopy versus k-wire fixation with fluoroscopy for distal phalangeal fractures: a comparative study. Eur J Orthop Surg Traumatol 31:705–710. https://doi.org/10.1007/s00590-020-02822-zCrossRefPubMed

17.

Lipira AB, Sood RF, Tatman PD et al (2015) Complications within 30 days of hand surgery: an analysis of 10,646 patients. J Hand Surg Am 40:1852-1859.e3. https://doi.org/10.1016/j.jhsa.2015.06.103CrossRefPubMed

18.

Rhee PC, Fischer MM, Rhee LS et al (2017) Cost savings and patient experiences of a clinic-based, wide-awake hand surgery program at a military medical center: a critical analysis of the first 100 procedures. J Hand Surg Am 42:e139–e147. https://doi.org/10.1016/j.jhsa.2016.11.019CrossRef

19.

Platt AJ, Page RE (1995) Post-operative infection following hand surgery. Guidelines for antibiotic use. J Hand Surg Br 20:685–690. https://doi.org/10.1016/s0266-7681(05)80137-8CrossRefPubMed

20.

Mehdinasab SA, Pipelzadeh MR, Sarrafan N (2012) Results of primary extensor tendon repair of the hand with respect to the zone of injury. Arch trauma Res 1:131–134. https://doi.org/10.5812/atr.7859CrossRefPubMedPubMedCentral

21.

Collocott SJ, Kelly E, Ellis RF (2018) Optimal early active mobilisation protocol after extensor tendon repairs in zones V and VI: a systematic review of literature. Hand Ther 23:3–18. https://doi.org/10.1177/1758998317729713CrossRefPubMed

22.

Eberlin KR, Ring D (2015) Infection after hand surgery. Hand Clin 31:355–360. https://doi.org/10.1016/j.hcl.2014.12.007CrossRefPubMed

Title: Safety of immediate open traumatic extensor tendon repair performed at an emergency department minor procedure room
Authors: Tal Frenkel Rutenberg
Elkin Leon Galvis
Oren Michaeli
Tuna Ozyurekoglu
Publication date: 10-11-2023
Publisher: Springer Berlin Heidelberg
Keywords: Extensor Tendon
Local Anesthesia in Dentistry
Hand Injury
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 1/2024
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-05115-2

At a glance: The STEP trials

Springer Medicine

Safety of immediate open traumatic extensor tendon repair performed at an emergency department minor procedure room

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2024

Bilateral simultaneous knee arthroplasty shows comparable early outcome and complication rate as staged bilateral knee arthroplasty for patients scored ASA 1–3 if performed by a high-volume surgeon: a retrospective cohort study of 127 cases

The 'Holy Grail' of shoulder dislocations: a systematic review on traumatic bilateral luxatio erecta; is it in reality a once-in-a-lifetime experience for an orthopaedic surgeon?

Increased femoral anteversion in females with anterior knee pain relates to both the neck and the shaft of the femur

Hinge prostheses in the revision of unicompartmental knee replacement: a descriptive analysis of data from the national joint registry for England, Wales and Northern Ireland

Increased accuracy in component positioning using an image-less robotic arm system in primary total knee arthroplasty: a retrospective study

Does experience with total knee arthroplasty in morbidly obese patients effect surgical outcomes