Management of partial extensor tendon lacerations of the hand and forearm: A national survey of practice in the United Kingdom

Background: Partial extensor tendon lacerations of the hand and forearm are common. There is a lack of evidence to guide their management and it is also unclear at what threshold surgeons would consider repair necessary. This study aimed to identify national surgical management of partial extensor tendon lacerations of the hand and forearm (zones 2-8) and assess surgeons' willingness to randomise in a future trial.

Methods: A 34-item online survey was developed by the steering group and, via a trainee-led collaborative model, was disseminated to plastic and orthopaedic surgeons in the UK. Summary data were calculated for each survey item, and the variations between zones and specialties were explored using linear regression.

Results: 142 complete responses were recorded (response rate 71%). On average, respondents said that 46% tendon division was the maximum they would manage in clinical practice without surgical repair. There was no significant difference in this percentage between zones or surgical specialties. Importantly, the majority (83%) of surgeons would be willing to randomise patients in a clinical trial to repair versus no-repair, within 29%-61% tendon division, demonstrating clinical equipoise.

Conclusions: There is significant variation in UK practice regarding the surgical management of partial extensor tendon lacerations of the hand and forearm and clinical equipoise exists regarding the decision to repair or not. A definitive randomised trial is warranted to identify the optimum management of this common injury.