Patterns in flexor zone V injury: a retrospective study

Abstract

Background: Volar cut injuries to the wrist that range from simple to complex full house and are commonly encountered by plastic surgery residents. In this study we aim to recognize common clusters of structures injured together, to decipher patterns in presentation and to assert the role of superficial tendons in protecting the nerves, vessels and the deeper tendons in the flexor compartment. Methods: This is a retrospective cross-sectional study analyzing 322 patients with acute Zone V injuries. The patients were profiled based on demographic factors and etiology of injury. Detailed analysis of morphology of injury, structures involved was done and grouped into six common injury patterns. Results: Majority of subjects were in the age group 21 to 30 years (33.9%), 81.1% were males and 18.9% were females. Both the sides flexor carpi radialis, Palmaris longus and flexor digitorum superficialis were commonly injured structures. Most common etiology was cutting tools. The median number of structures injured in cutting injuries was 3, in deliberate self-harm was 3, in Power tool was 6, in Shard injuries was 5 structures. Distribution of injuries was pattern 1 (98.2%), pattern 2 (36.2%), pattern 3 (40.5%), pattern 4 (80.1%), pattern 5 (15.6%) and pattern 6 (21.5%). Pattern 1 was seen commonly in all etiologies whereas power tools were responsible for serious pattern 6 types of injuries. Conclusions: Cut injury to wrist occurs as clusters of specific structures and these patterns need to be looked for during surgical repair of hand. Superficial tendons have a role in protecting deeper tendons and neurovascular structures.