Accuracy of the preoperative examination in Zone 5 wrist lacerations

Fifty patients were studied to determine the accuracy of the preoperative physical examination in flexor tendon Zone 5 wrist lacerations. Initially, a retrospective review of the charts of 33 patients who were examined by a second- or third-year postgraduate physician was done. An average of three errors per examination was found. Then a prospective study of 17 patients was performed to see if an examiner's level of training in hand surgery influenced the accuracy of the examination. Error rates improved slightly with experience. Ninety-seven examinations were performed in the combined prospective and retrospective studies, and only 13 were completely correct. Nearly 1/2 of all examinations had three or more errors. If a structure had been lacerated, the injury was not detected 33% of the time on the preoperative examination. The size and mechanism of injury of the skin laceration did not correlate with the number of structures that were cut.