Functional Outcome In Repair of Zone V Flexor Tendon Injuries in a Tertiary Care Centre in Kerala

Objective: Zone V flexor tendon injuries are complex hand injuries frequently associated with neurovascular damage, posing significant challenges in surgical repair and rehabilitation. This study aimed to evaluate the short-term functional outcomes and quality of life following surgical repair of Zone V flexor tendon injuries using standardized outcome measures at a tertiary care centre in Kerala, India.

Methods: A prospective cohort study was conducted over a 6-month period at the Department of Plastic and Reconstructive Surgery, Government Medical College, Thiruvananthapuram. Fifty patients with isolated Zone V flexor tendon injuries were enrolled. Tendon repair was performed using the Modified Kessler four-strand technique. Functional outcomes were assessed at 1 month and 3 months postoperatively using the Buck-Gramcko and Quick DASH scoring systems. Quality of life was evaluated at 3 months using the SF-36 questionnaire. Statistical analysis was performed using SPSS version 27.0.

Results: Significant improvement in functional scores was observed from 1 to 3 months postoperatively. Buck-Gramcko scores improved by a mean of +2.2 points (p<0.001; Cohen's d=0.75), while Quick DASH scores showed a median reduction of −13 points (p<0.001; r=0.58). Younger patients (<30 years), those with higher education, non-diabetics, non-smokers, and those who underwent early surgery (<48 hours) had significantly better outcomes. Patients with nerve involvement, multiple-digit injuries, or secondary infections demonstrated poorer recovery. SF-36 scores reflected superior quality of life in younger, educated, and non-comorbid patients.

Conclusion: Zone V flexor tendon injuries, when managed with timely surgical intervention and structured rehabilitation, yield favourable short-term functional and quality of life outcomes. Early repair, absence of comorbidities, patient education, and therapy compliance are critical determinants of recovery, particularly in resource-limited settings.