Finger-Wise Clinical and Functional Outcomes of Single-Stage Flexor Tendon Reconstruction in Zone II

Abstract

Background: Flexor tendon injuries in Zone II represent one of the most challenging upper-limb traumas due to complex anatomy and a high risk of adhesion formation. Although single-stage tendon reconstruction is an established technique, finger-specific functional outcomes remain under-reported. Therefore, this study aims to evaluate the clinical and finger-wise functional outcomes following single-stage flexor tendon reconstruction for chronic Zone II injuries.

Methods: This prospective observational study at the Department of Orthopaedic Surgery, Bangladesh Medical University, Dhaka, Bangladesh (January 2024–December 2025) included 40 participants with 110 injured fingers undergoing single-stage reconstruction. Demographics, injury characteristics, graft type, complications, and outcomes were recorded. Functional outcomes were assessed using Total Active Motion and Buck–Gramcko grading, with chi-square and Kruskal–Wallis tests for analysis.

Results: Most patients were young males (82.5%), commonly injured by sharp knife cuts (60%). The ring (28.2%) and little (27.4%) fingers were most frequently affected. Overall, 85% achieved excellent/good outcomes (40% excellent, 45% good). Nail–palm distance and total active motion improved significantly in all digits (p < 0.001), while extension deficit improved significantly in the index (p = 0.026), middle (p = 0.029), ring (p = 0.021), and little fingers (p = 0.042) but not in the thumb (p = 0.175). Complications occurred in 22.5%, most commonly swan-neck deformity (10%).