Functional Recovery Measurement : Comparing Early Active Mobilization Versus Immobilization After Extensor Tendon Repair in Zones IV to VIII

Dynamic splinting following extensor tendon repair gives better results than static splinting, but involves cumbersome splints and recommended protocols are often complicated. We prefer controlled active mobilization of extensor tendon repairs without dynamic splinting. Six weeks after repair, excellent or good function was obtained in 22 out of 24 simple extensor tendon injuries and in 11 out of 13 complex injuries. The results of this prospective study are comparable with those reported after dynamic splinting; this regime does not require outrigger splintage and is simple to follow.

Download Full-text

Functional outcome of zone 5 to zone 8 extensor tendon injuries of hand managed with early active mobilization following repair using a static splint: an observational study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210483 ◽

2021 ◽

Vol 7 (2) ◽

pp. 234

Author(s):

Sourav Bhattacharjee ◽

Ashir Abdul Rasheed ◽

Binu Alex

Keyword(s):

Observational Study ◽

Functional Outcome ◽

Functional Outcomes ◽

Tendon Repair ◽

Early Mobilization ◽

Extensor Tendon ◽

P Value ◽

Poor Outcome ◽

Active Mobilization ◽

Extensor Tendon Injuries

Background: Injuries to extensor tendons of the hand are underrepresented in the literature compared to flexor tendons. The concept of early mobilization following extensor tendon repair emerged as previous strategies of static immobilization lead to frequent adhesions and poor outcome. In our study we assessed the functional outcome of early active mobilization after extensor tendon repair using a static splint. Methods: In this observational study 42 patients with 48 extensor tendon severances of the hand from zone 5 to 8 were selected. Following repair, early active mobilization with a static splint was done and the functional outcomes were assessed using the Dargan criteria. Results: After mobilizing for 4 weeks, out of total 48 patients, 18 (43%) had good outcomes, 19 (45%) had fair and 5 patients (12%) had poor outcome. After 6 weeks 14 patients (33.3%) had excellent, 20 patients (48%) had good and 6 patients (14%) had fair outcomes whereas only one patient (2.4%) had poor outcome. This result was statistically significant with a p value of 0.000.Conclusions: Early active mobilization following extensor tendon repair from zone 5 to 8 prevents adhesion around the repair site, leads to better post-operative outcome and faster recovery. Using a static splint along with a patient friendly, easily comprehensible rehabilitation protocol offers results comparable to the use of dynamic splints and requires fewer post-operative follow ups. The static splints being cheap, easy to construct are financially beneficial to the patients.

Download Full-text

Outcome of early active mobilization after extensor tendon repair

Indian Journal of Orthopaedics ◽

10.4103/0019-5413.41859 ◽

2008 ◽

Vol 42 (3) ◽

pp. 336 ◽

Cited By ~ 4

Author(s):

Narender Saini ◽

Mohan Sharma ◽

VD Sharma ◽

Purnima Patni

Keyword(s):

Tendon Repair ◽

Extensor Tendon ◽

Active Mobilization

Download Full-text

Dynamic Splinting After Extensor Tendon Repair in Zones V to VII

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(03)00014-7 ◽

2003 ◽

Vol 28 (3) ◽

pp. 224-227 ◽

Cited By ~ 35

Author(s):

S. BRÜNER ◽

M. WITTEMANN ◽

A. JESTER ◽

K. BLUMENTHAL ◽

G. GERMANN

Keyword(s):

Retrospective Study ◽

Surgical Complication ◽

Tendon Repair ◽

Extensor Tendon ◽

Tendon Injuries ◽

Active Motion ◽

Evaluation Systems ◽

Dynamic Splinting ◽

Extensor Tendon Injuries

This retrospective study evaluates a dynamic active motion protocol for extensor tendon repairs in zones V to VII. Fifty-eight patients with 87 extensor tendon injuries were examined. Using Geldmacher’s and Kleinert and Verdan’s evaluation systems, the results were graded as “excellent” and “good” in more than 94%, and as “satisfactory” in the remainder. The need for secondary tenolysis was low (6%), and no other surgical complication occurred.

Download Full-text

Flexor tendon repair: recent changes and current methods

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211053757 ◽

2021 ◽

pp. 175319342110537

Author(s):

Jin Bo Tang ◽

Donald Lalonde ◽

Leila Harhaus ◽

Ahmed Fathy Sadek ◽

Koji Moriya ◽

...

Keyword(s):

Functional Recovery ◽

Flexor Tendon ◽

Tendon Repair ◽

Hand Surgery ◽

Past Experience ◽

Current Status ◽

Flexor Tendon Repair ◽

Clinical Methods

The current clinical methods of flexor tendon repair are remarkably different from those used 20 years ago. This article starts with a review of the current methods, followed by presentation of past experience and current status of six eminent hand surgery units from four continents/regions. Many units are using, or are moving toward using, the recent strong (multi-strand) core suture method together with a simpler peripheral suture. Venting of the critical pulleys over less than 2 cm length is safe and favours functional recovery. These repair and recent motion protocols lead to remarkably more reliable repairs, with over 80% good or excellent outcomes achieved rather consistently after Zone 2 repair along with infrequent need of tenolysis. Despite slight variations in repair methods, they all consider general principles and should be followed. Outcomes of Zone 2 repairs are not dissimilar to those in other zones with very low to zero incidence of rupture.

Download Full-text

Incidence of tenolysis and features of adhesions in the digital flexor tendons after multi-strand repair and early active motion

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193418809796 ◽

2018 ◽

Vol 44 (4) ◽

pp. 354-360 ◽

Cited By ~ 11

Author(s):

Koji Moriya ◽

Takea Yoshizu ◽

Naoto Tsubokawa ◽

Hiroko Narisawa ◽

Yutaka Maki

Keyword(s):

Flexor Tendon ◽

Full Range ◽

Tendon Repair ◽

The Other ◽

Flexor Digitorum Superficialis ◽

Flexor Tendon Repair ◽

Level Of Evidence ◽

Active Motion ◽

Active Mobilization ◽

Flexor Digitorum

We report seven patients requiring tenolysis after primary or delayed primary flexor tendon repair and early active mobilization out of 148 fingers of 132 consecutive patients with Zone 1 or 2 injuries from 1993 to 2017. Three fingers had Zone 2A, two Zone 2B, and two Zone 2C injuries. Two fingers underwent tenolysis at Week 4 or 6 after repair because of suspected repair rupture. The other five fingers had tenolysis 12 weeks after repair. Adhesions were moderately dense between the flexor digitorum superficialis and profundus tendons or with the pulleys. According to the Strickland and Tang criteria, the outcomes were excellent in one finger, good in four, fair in one, and poor in one. Fingers requiring tenolysis after early active motion were 5% of the 148 fingers so treated. Indications for tenolysis were to achieve a full range of active motion in the patients rated good or improvement of range of active motion of the patients rated poor or fair. Not all of our patients with poor or fair outcomes wanted to have tenolysis. Level of evidence: IV

Download Full-text

Clinical results of releasing the entire A2 pulley after flexor tendon repair in zone 2C

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193416646521 ◽

2016 ◽

Vol 41 (8) ◽

pp. 822-828 ◽

Cited By ~ 28

Author(s):

K. Moriya ◽

T. Yoshizu ◽

N. Tsubokawa ◽

H. Narisawa ◽

K. Hara ◽

...

Keyword(s):

Flexor Tendon ◽

Tendon Repair ◽

Clinical Results ◽

The Other ◽

Flexor Tendon Repair ◽

Level Of Evidence ◽

A2 Pulley ◽

Active Mobilization ◽

Finger Motion

We report the results of complete release of the entire A2 pulley after zone 2C flexor tendon repair followed by early postoperative active mobilization in seven fingers and their comparisons with 33 fingers with partial A2 pulley release. In seven fingers, release of the entire A2 pulley was necessary to allow free gliding of the repairs in five fingers and complete release of both the A2 and C1 pulleys was necessary in two. No bowstringing was clinically evident in any finger. Two fingers required tenolysis. Using Tang’s criteria, the function of two digits was ranked as excellent, four good and one fair; there was no failure. The functional return in these seven fingers was similar with that in 33 fingers with partial A2 pulley release; in these patients only one finger required tenolysis. Our results support the suggestion that release of the entire A2 pulley together with the adjacent C1 pulley does not clinically affect finger motion or cause tendon bowstringing, provided that the other pulleys are left intact. Level of evidence: IV

Download Full-text

Predictors of outcome after primary flexor tendon repair in zone 1, 2 and 3

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193416657758 ◽

2016 ◽

Vol 41 (8) ◽

pp. 793-801 ◽

Cited By ~ 35

Author(s):

I. Z. Rigo ◽

M. Røkkum

Keyword(s):

Flexor Tendon ◽

Linear Regression Analysis ◽

Tendon Repair ◽

Tendon Sheath ◽

Multiple Linear Regression Analysis ◽

Level Of Evidence ◽

Pulley System ◽

Skeletal Injury ◽

Active Mobilization

We retrospectively reviewed the outcomes of flexor tendon repairs in zones 1, 2 and 3 in 356 fingers in 291 patients between 2005 and 2010. The mean (standard deviation) active ranges of motion of two interphalangeal joints of the fingers were 98° (40) and 114° (45) at 8 weeks postoperatively and at the last follow-up (mean 7 months, range 3–98), respectively. Using the Strickland criteria, ‘excellent’ or ‘good’ function was obtained in 95 (30%) out of 322 fingers at 8 weeks and 107 (48%) out of 225 fingers at the last follow-up. A total of 48 (13%) fingers required reoperation because of rupture, adhesion, contracture or other complications. The prevalence of rupture was 4%. We carried out multiple linear regression analysis to identify the predictors of the active digital motion. The following variables were found as negative predictors: age; smoking; injury localization between subzones 1C and 2C; injury to the little finger; the extent of soft tissue damage; concomitant skeletal injury; delay to surgery; use of a 2-strand Kessler repair technique; attempted suture or preservation of the tendon sheath–pulley system; and resecting or leaving the concomitant superficial flexor tendon cuts untreated. Analysing the 8 weeks results of tendon repairs in zones 1 and 2, early active mobilization was found to be superior to Kleinert’s regime. Level of evidence: III

Download Full-text