title: Prognostic factors in two-stage flexor tendon reconstruction: Is it possible to predict surgical failure?
abstract: BACKGROUND
  Two-stage surgical reconstruction of the flexor tendons by the Hunter technique is the salvage option in case of old tears or a severely damaged fibro-osseous canal.
  
  
  OBJECTIVE
  The identification of poor prognostic factors during the assessment of injuries at presentation could help determine indications and predict failures.
  
  
  METHODS
  We report a retrospective single center series of reconstruction of zone 2 of the flexor digitorum profundus of the long fingers between 2000 and 2012, in 22 patients, mean age 33 years old with a mean follow-up of 36.4 months.
  
  
  RESULTS
  The total active range of motion (TAM) of the rays was 110° with a mean range of motion of the PIP and DIP of 71° and 39° respectively. Sixty-three percent of patients were satisfied and 73% returned to their professional activities. A group with good and fair results was determined based on the Strickland classification (68%, 15 patients, mean TAM 126°, mean QuickDASH 22.6) and a group with poor results (32%, 7 patients, mean TAM 77°, mean QuickDASH 43.4). The factors of a poor prognosis were associated injuries to the extensor apparatus, infection (phlegmon) (P=0.023) and joint injuries (P=0.09).
  
  
  CONCLUSIONS
  There are no factors in the literature to predict a poor prognosis except for reconstruction of the flexor pollicis longus. A simplified procedure could provide better results in patients with associated injuries to the extensor apparatus, infection (phlegmon) or osteoarticular damage, in terms of the duration of physical therapy, additional surgery and overall socioeconomic cost. The results in the literature of superficialis finger reconstruction are significantly better (P<0.001).
  
  
  CONCLUSIONS
  Although the Hunter technique is still the reference procedure for the reconstruction of flexor tendons, our study identified prognostic factors of poor functional results such as infection and associated extensor apparatus damage, which should orient the surgeon towards a simplified technique such as the superficialis finger procedure.
  
  
  METHODS
  IV: retrospective study.
authors.affiliation: Service de chirurgie de la main et du membre supérieur chirurgie des paralysies, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France. Electronic address: iskander.djerbi@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Djerbi
authors.affiliation: Service de chirurgie de la main et du membre supérieur chirurgie des paralysies, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
authors.forename: M
authors.initials: M
authors.lastname: Chammas
authors.affiliation: Service de chirurgie de la main et du membre supérieur chirurgie des paralysies, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
authors.forename: M-P
authors.initials: MP
authors.lastname: Mirous
authors.affiliation: Service de chirurgie de la main et du membre supérieur chirurgie des paralysies, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
authors.forename: C
authors.initials: C
authors.lastname: Lazerges
authors.affiliation: Service de chirurgie de la main et du membre supérieur chirurgie des paralysies, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
authors.forename: B
authors.initials: B
authors.lastname: Coulet
mesh_terms: D000328:Adult; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011379:Prognosis; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000601:surgery; D017211:Treatment Failure
keywords: Flexor tendons; Hunter; Prognostic factors; Superficialis finger; Tendon reconstruction