Concerning patients suffering from social deprivation, access to hand therapy is often limited. Consequences of non-adherence to the postoperative protocol after flexor tendon repair can be devastating, such as secondary rupture, infection, and limited range of motion. The purpose of this study was to compare the outcomes of flexor tendon repair between socially deprived patients and those who weren’t.

We retrospectively analyzed a cohort of 122 patients who presented flexor tendon injuries, surgically repaired between January 2021 and January 2023. All the care took place at a single public institution where socially deprived patients benefit from free consultations, physical therapy, dressing changes and thermoformed splints.

We found a shorter length of follow up (1.82 v. 4.77 months), a higher number of lost to follow up in the socially deprived group (55% vs 33%), a lower compliance to splint wear (60% vs 82%) and physical therapy (38% vs 70%). There were more postoperative infections in socially deprived patients we could follow than in the socially integrated group (8% vs 0%). There were no significant differences in terms of range of motion nor repeat surgery (25% vs 16%) amongst those who had at least two months follow up.

French public hospitals accept patients without insurance. Although these infrastructures require elevated expenses from the healthcare system, these seem necessary from a humanist point of view. An interesting complement to the results we observed is the analysis of the differences in expenses incurred by the inability of socially deprived patients to return to work, and the expenses that a prolonged hospital stay in order to educate the patient on physical therapy and wound dressing would represent. Indeed, a 4-to-5-day hospital stay during which the patient meets with a translator, learns flexor tendon repair rehabilitation protocol with the inhouse physical therapist and wound dressings would help with better return to work conditions, estimated at 13,414?. When compared to the risk of job loss, long-term social disability benefits, decline in quality of life and economical sustainability a few days hospitalization could seem beneficial in certain situations.

In conclusion, although comprehensive postoperative care is free, socially deprived patients have lower rates of follow up, and more postoperative infections. Nevertheless, the real difference in outcomes remains unclear, as there is a large number of lost to follow-up in the socially deprived group.