The Outcomes of Extensor Tendon Repair Based on Timing of Repair.

Background: Little is known regarding the effect timing of repair has on extensor tendon repair results. The purpose of this study is to determine if a relationship exists between the time of extensor tendon injury to extensor tendon repair and patient outcomes. Methods: A retrospective chart review was conducted on all patients that underwent extensor tendon repair at our institution. The minimum time to final follow-up was 8 weeks. Patients were then divided into two cohorts for analysis; those that underwent repair less than 14 days after injury and those that underwent extensor tendon repair at or greater than 14 days after injury. These cohorts were further sub-grouped by zone of injury. Data analysis was then completed using a two-sample t-test assuming unequal variance and ANOVA for categorical data. Results: A total of 137 digits were included in final data analysis, with 110 digits repaired less than 14 days from injury and 27 digits in the greater than or equal to 14 days to surgery group. For zones 1-4 injuries, 38 digits were repaired in the acute surgery group and eight digits in the delayed surgery group. There was no significant difference in final total active motion (TAM) (142.3° vs. 137.4°). Final extension was also similar between the groups (2.37° vs. 2.13°). For zones 5-8 injuries, 73 digits were repaired acutely, and 13 digits were repaired in delayed fashion. There was no significant difference in final TAM (199.4° vs. 172.7°). Final extension was also similar between the groups (6.82° vs. 5.77°). Conclusions: We found time from extensor tendon injury to surgical repair did not affect final range of motion when comparing acute repair within 2 weeks from injury or delayed repair greater than 14 days from injury. Additionally, there was no difference in secondary outcomes, such as return to activity or surgical complications. Level of Evidence: Level IV (Therapeutic).

Extensor Tendon Repair Outcomes Based on Zone of Injury.

BACKGROUND: The purpose of this study was to examine the clinical outcomes of extensor tendon repairs based on zone of injury. METHODS: A retrospective chart review was conducted on all patients who underwent primary extensor tendon repair at our institution. Extensor tendon repairs were performed using a multiple figure-of-8 suture technique for extensor zones 1-4 and a modified Kessler suture technique for extensor zones 5-8. Inclusion criteria included a minimum of 8 weeks of follow-up, complete data available for review, and extensor tendon injury requiring primary surgical repair. RESULTS: A total of 132 digits were included for analysis: 46 digits in zones 1-4 and 86 digits in zones 5-8. The operative time for zone 1-4 injuries averaged 88.96 minutes, and the operative time for zone 5-8 injuries averaged 114.42 minutes. Final extension was found to be 2.33° for zones 1-4 and 6.66° for zones 5-8. Final flexion was found to be 141.4° for zones 1-4 and 195.3° for zones 5-8. There was 1 infection identified in zones 1-4 and 7 in zones 5-8. CONCLUSIONS: Surgically repaired extensor tendons in zones 1-4 were found to have a statistically significant worse final flexion compared with surgically repaired extensor tendons in zones 5-8. No significant differences were found in final extension, complication rates, and time to full activity. Operative times for zone 5-8 tendon repairs were found to be significantly longer than operative times for zone 1-4 repairs, possibly due to more complex injury patterns seen in the more proximal zones.

Biomarkers for Wilms Tumor: A Systematic Review.

PURPOSE: Wilms tumor is the most common childhood renal malignancy and the fourth most common childhood cancer. Many biomarkers have been studied but there has been no comprehensive summary. We systematically reviewed the literature on biomarkers in Wilms tumor to quantify the prognostic implications of the presence of individual tumor markers. MATERIALS AND METHODS: We searched for English language studies from 1980 to 2015 performed in patients younger than 18 years with Wilms tumor and prognostic data. The protocol was conducted per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two reviewers abstracted data in duplicate using a standard evaluation form. We performed descriptive statistics, then calculated relative risks and 95% confidence intervals for markers appearing in multiple level II or III studies. RESULTS: A total of 40 studies were included examining 32 biomarkers in 7,381 patients with Wilms tumor. Studies had a median of 61 patients, 24 biomarker positive patients per series and a median followup of 68.4 months. Median percentages of patients with stages 1, 2, 3, 4 and 5 tumors were 28.5%, 26.4%, 24.5%, 14.1% and 1.7%, respectively, and 10.2% had anaplasia. The strongest negative prognostic association was loss of heterozygosity at 11p15, with a risk of recurrence of 5.00, although loss of heterozygosity at 1p and gain of function at 1q were also strongly linked to increased recurrence (2.93 and 2.86, respectively). CONCLUSIONS: Several tumor markers are associated with an increased risk of recurrence or a decreased risk of overall survival in patients with Wilms tumor. These data suggest targets for development of diagnostic tests and potential therapies.