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Rehabilitation Following Zone II Flexor Tendon Repairs: A Change to Splinting Practice Using the Manchester Short Splint
PAPER 51 Clinical Paper Session 11: Tendon Saturday, October 5, 2013 9:55e10:01 AM Category: Workplace/Rehabilitation Keyword: Hand
Rehabilitation Following Zone II Flexor Tendon Repairs: A Change to Splinting Practice Using the Manchester Short Splint Level 3 Evidence
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Chye Ng, MBChB(Hons), FRCS(T&O), DSEM, BDHS, EBHSD Fiona Peck, MCSP Alison Roe, MCSP Christopher G. Duff, FRCS(Plas) Duncan A. McGrouther, MD, FRCS Vivien C. Lees, MD, FRCS
Null Hypothesis: There is no statistically significant difference in the outcomes (range of motion and rupture rate) after zone II flexor tendon repairs, when comparing the traditional forearm-based splint and a newly designed short splint. Methods: We performed a historical cohort study of patients with primary zone II flexor tendon lacerations, repaired using multi-strand suture techniques. The results of rehabilitation using a traditional forearm-based splint (Fig. 1) were compared with the Manchester short splint (Fig. 2). The short splint was fabricated to permit maximal wrist flexion and up to 45 wrist extension with a block to 30 metacarpophalangeal joint extension. Rehabilitation began on the fourth or fifth postoperative day, using early
© Speaker has nothing of financial value to disclose
combined passive and active motion, and patients were offered weekly therapy appointments. All patients were instructed to wear the splints for a period of 6 weeks. Range of motion of the injured digit was measured by a clinical specialist hand therapist using a digital goniometer at 6 and 12 weeks postoperatively. Results: In 2011, 62 patients (76 digits) (mean age, 34 y; range, 14e58 y) with acute, uncomplicated zone II flexor tendon injuries were rehabilitated using the forearm-based splint (group A). In 2012, 40 patients (45 digits) (mean age, 31 y; range, 15e71 y) with the same injuries were rehabilitated using the Manchester short splint (group B). At 6 weeks postoperatively, group B had significantly less mean flexion contractures at the proximal interphalangeal (PIP) joints (mean SD, 18 14 ) than group A (29 18 ) (t-test; P < .001). The mean arc of PIP joint motion was also greater in group B than group A (53 23 vs 41 24 ; P ¼ .008). Similarly, at the distal interphalangeal joints, group B had significantly less mean flexion contractures than group A (6 9 vs 10 10 ; P ¼ .034). At 12 weeks postoperatively, group B continued to have significantly less mean flexion contractures than group A at the PIP joints (10 11 vs 19 16 ; P ¼ .002). During the study period, there were 3 ruptures (3.9%) in group A and 2 (4.4%) in group B (chi-square test with Yates’ correction; P ¼ .735). Summary: The Manchester short splint appears to be a safe, simple, and effective splint for rehabilitation of patients with zone II flexor tendon repairs. Patients had significantly fewer flexion contractures at the PIP joints and regained greater range of active motion of the digits at 12 weeks postoperatively. The rupture rate remains within published acceptable levels (4%).
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Rehabilitation Following Zone II Flexor Tendon Repairs: A Change to Splinting Practice Using the Manchester Short Splint Level 3 Evidence
© © © © © ©
Chye Ng, MBChB(Hons), FRCS(T&O), DSEM, BDHS, EBHSD Fiona Peck, MCSP Alison Roe, MCSP Christopher G. Duff, FRCS(Plas) Duncan A. McGrouther, MD, FRCS Vivien C. Lees, MD, FRCS
Null Hypothesis: There is no statistically significant difference in the outcomes (range of motion and rupture rate) after zone II flexor tendon repairs, when comparing the traditional forearm-based splint and a newly designed short splint. Methods: We performed a historical cohort study of patients with primary zone II flexor tendon lacerations, repaired using multi-strand suture techniques. The results of rehabilitation using a traditional forearm-based splint (Fig. 1) were compared with the Manchester short splint (Fig. 2). The short splint was fabricated to permit maximal wrist flexion and up to 45 wrist extension with a block to 30 metacarpophalangeal joint extension. Rehabilitation began on the fourth or fifth postoperative day, using early
© Speaker has nothing of financial value to disclose
combined passive and active motion, and patients were offered weekly therapy appointments. All patients were instructed to wear the splints for a period of 6 weeks. Range of motion of the injured digit was measured by a clinical specialist hand therapist using a digital goniometer at 6 and 12 weeks postoperatively. Results: In 2011, 62 patients (76 digits) (mean age, 34 y; range, 14e58 y) with acute, uncomplicated zone II flexor tendon injuries were rehabilitated using the forearm-based splint (group A). In 2012, 40 patients (45 digits) (mean age, 31 y; range, 15e71 y) with the same injuries were rehabilitated using the Manchester short splint (group B). At 6 weeks postoperatively, group B had significantly less mean flexion contractures at the proximal interphalangeal (PIP) joints (mean SD, 18 14 ) than group A (29 18 ) (t-test; P < .001). The mean arc of PIP joint motion was also greater in group B than group A (53 23 vs 41 24 ; P ¼ .008). Similarly, at the distal interphalangeal joints, group B had significantly less mean flexion contractures than group A (6 9 vs 10 10 ; P ¼ .034). At 12 weeks postoperatively, group B continued to have significantly less mean flexion contractures than group A at the PIP joints (10 11 vs 19 16 ; P ¼ .002). During the study period, there were 3 ruptures (3.9%) in group A and 2 (4.4%) in group B (chi-square test with Yates’ correction; P ¼ .735). Summary: The Manchester short splint appears to be a safe, simple, and effective splint for rehabilitation of patients with zone II flexor tendon repairs. Patients had significantly fewer flexion contractures at the PIP joints and regained greater range of active motion of the digits at 12 weeks postoperatively. The rupture rate remains within published acceptable levels (4%).
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