Evaluation of accuracy of preoperative examination of flexor tendons in zone 4 and 5 of hand injuries

Hand injuries due to lacerations are one of the most common causes of hand emergencies which are due to diverse reasons as occupational, sport injuries or self mutilation. Tendons’ damages are the most common injuries of hand. Precise preoperative examination may reduce diagnostic errors. This study evaluated the accuracy of preoperative examinations of flexor tendons injuries in zone 4 and 5 of hand. In a cross-sectional descriptive study, preoperative physical examination by plastic surgery team and findings during the surgery were compared in 61 cases referring to hand emergency operating room of 15 Khordad Hospital, Tehran. Data collection was preformed by means of questionnaires pre and post operation. All cases with hand lacerations of zone 4 & 5 were enrolled; whereas children younger than 3 years of age, and the non-cooperative cases and those of any history of previous handsurgery, were excluded from the study. Sensitivity, specificity, positive and negative predictive values were analyzed, using SPSS software. The accuracy of preoperative examination findings for all tendons was 88.52%. This was more accurate in flexor digitorum profundus (FDP) (96.72%) than flexor digitorum superficialis (FDS) tendons (78.27%). The specificity of preoperative examination (99.50%) was more than sensitivity (57.63%) for all tendons. Sensitivity of examination for FDS and FDP was 40.69% and 82.75% respectively and specificity was 98.73% and 100% for FDS and FDP respectively. More attention is mandatory during preoperative examination of the hand with zone 4 & 5 injuries. Surgeons need a low exploratory threshold, and in cases with any positive finding of tendon injury, explorative surgery is recommended.