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This systematic review examines the incidence of tenolysis and its clinical effects following hand fracture surgery.

February 28, 2026

Tenolysis after Operative Treatment of Hand Fractures: A Systematic Review

Key Points

This systematic review examines the incidence of tenolysis and its clinical effects following hand fracture surgery.
Systematic review conducted per PRISMA guidelines
Databases searched included CINAHL, Cochrane Central, Embase, PubMed, and Web of Science
Included studies on patients 16 years or older who underwent tenolysis for tendon adhesions after hand fractures
Outcomes assessed included incidence of tenolysis and range of motion measures post-tenolysis
Quality of included studies evaluated using various appraisal tools
Eight studies included out of 160 initially identified
Incidence of tenolysis in phalangeal fractures ranged from 4% to 32%
Statistical improvement in active range of motion for PIP joint noted in one study (p = 0.012)
Included studies generally rated poor to fair in quality
No conclusive evidence regarding tenolysis' clinical effects on joint motion was found

Abstract

Background: Stiffness based on tendon adhesions after operative treatment of hand fractures remains a relevant complication, for which tenolysis may be needed. This systematic review aims to analyse the incidence of tenolysis after surgical hand fracture treatment and related clinical outcomes. Methods: The review was performed according to the PRISMA guidelines. CINAHL, Cochrane Central Register of Controlled Trials/Clinical Answers/Database of Systematic Reviews, Embase, PubMed and Web of Science were searched for articles until 31 December 2024, using keywords. Studies were included in the case of patients aged 16 years or older, who have undergone tenolysis for flexor and/or extensor tendon adhesions after surgical treatment of phalangeal and/or metacarpal fractures. The outcomes were the incidence of tenolysis and total active motion, passive and/or active range of motion (P/AROM) and lag of motion post-tenolysis. The included articles were assessed for methodological quality and risk of bias using the Critical Appraisal Skills Programme checklists, the Joanna Briggs Institute critical appraisal tools and the National Institutes of Health quality assessment tools. Results: Eight out of 160 studies were included. These studies reported an incidence of tenolysis of surgically treated phalangeal fractures varying from 4% to 32%. Only the study of Wong et al. statistically analysed the AROM of the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint pre- to post-tenolysis, showing a significant improvement of the AROM of the PIP joint (p = 0.012). However, based on the quality assessment, the included articles have poor to fair quality. Conclusions: Based on these studies, no definite conclusions concerning the incidence and clinical effect of tenolysis in terms of improvement of MCP-, PIP- and DIP-joint motion can be drawn. Due to the lower quality of these studies, future high-quality research with prospective registration is needed. Level of Evidence: Level IV (Therapeutic)

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