Active mobilisation after flexor tendon repair: comparison of results following injuries in zone 2 and other zones

ABSTRACT

Purpose To prospectively inquiry the role of active mobilisation after flexor tendon repair.

Method The standard modified Kessler's technique was used to repair 46 digits in 32 patients with flexor tendon injuries. Early active mobilisation of the repaired digit was commenc upon the third postoperative day. Range of motion was monitored and recovery from injury in band 2 was compared with injury in other zones

Result There were 24 and 22 injuries in belt 2 and other zones respectively. The total active motion score of the American Society for Surgery of the Hand was measured. Patients with zone-2 injuries achieved similar rises to those with other-zone injuries apart from a 3-week delay in redemption The final results were advantageous to excellent in 71% and 77% of zone-2 and other-zone cases respectively (p

Conclusion. Preliminary be deriveds of this study showed that active mobilisation following flexor tendon repair provides comparable clinical issues and is as safe as conventional mobilisation programmes although recuperation in patients with zone-2 injury was delayed.

Key words: rehabilitation; tendon injuries

INTRODUCTION

Mobilisation following flexor tendon repair is essential for healing and repair. It has been shown experimentally that early motion stimulates tendon healing and decreases adhesion.1"4 Kleinert et al.5 and Lister et al.6 were among the first to report remarkable clinical arises using active extension-passive flexion mobilisation with the aid of a dynamic traction splint. Similar be the effects were subsequently reported by different authors.7,8 Nonetheless, flexion contracture of the finger may disclose and it has been difficult to achieve consistent flexion of the distal interphalangeal joint. The vexed question is caused by poor differential gliding between the superficialis and profundus tendons in cincture 2 with subsequent adhesion formation. The palmar pulley modification of the Kleinert splint may increase move at the distal interphalangeal joint on the other hand this modification is not applicable in all cases and may actually aggravate flexion contracture. Active mobilisation of the injured finger will clear up these problems because it provides differential gliding between the tendons in a normal physiological manner.9 Several studies have reported the follows of early active mobilisation and active extension-passive flexion mobilisation.10-16 We exhibited our own protocol of active mobilisation following tendon repair and examined the serial redemption of finger movement. The progres of rehabilitation between zone-2 and other-zone injuries was compared.

MATERIALS AND METHODS

A one-year consecutive series of 32 patients (28 males and 4 females) aged between 12 and 61 years (mean, 26 years) with flexor tendon injuries in all cinctures of the hand were admitted to the Prince of Wales Hospital, Hong Kong and prospectively studied. All patients had unilateral injuries: 20 involved the left hand and 12 involved the right hand. Of 46 injured digits, 24 (52%) were injured in baldric 2 and 22 (48%) in other baldrics (zone 1, n=5; zone 3 n=9; and band 5, n=8). Sharp-cut injuries accounted for 78% The remaining 22% were untidy injuries caused by the agency of crushing or machinery. Uncomplicated fractures or power injuries were also included, on the other hand extensor tendon injuries and finger replantations were exclud The greatest in quantity common associated injury was a make an incision in digital nerve (Table 1).

Tendons were repaired by means of the modified Kessler's method using a 2-strand core line of junction with 4/0 nylon and a circumferential running line of junction with 6/0 nylon. Both superficialis and profundus tendons were repaired and the flexor tendon sheath repaired if feasible. A compression dressing was applied for 2 days together with a dorsal plaster slab to maintain the wrist in 40?° flexion and extension arrest of the metacarpophalangeal joints at 90?° The hand was elevated. upon the third postoperative day, the compression dressing was remov and, if hurt healing was uncomplicated, a light dressing was applied. A thermoplastic dorsal splint was used to maintain the wrist in 40?° flexion, the metacarpophalangeal joints at 70?° flexion and dorsal extension blockade for the fingers at 0?° The fingers were unobstructed and able to stir freely (Fig. 1). An extension platform support to the fingers was usually given at night to support and immobilise the interphalangeal joints in extension.

Programme of active mobilisation

All patients commenc active finger mobilisation, supervised by the agency of an experienced therapist. The fingers were initially mobilised with the wrist splint in place. There was normally 30?° to 40?° flexion of the interphalangeal joints at quiescence The mobilisation programme consisted of kind flexion of the interphalangeal joints from this resting position for a further 20?° (flexion range, 30?°-50?°) followed by means of gentle slow extension to 0?° (full extension). Patients were then instructed to relax to allow passive recoil of the fingers back to the resting position. This circle of time of movement was repeated slowly with time breaks in between. The number of moves was arbitrary: usually 5 times with 2 to 3 sessions upon the first day. The range of flexion as well as the number of changes and sessions were slowly increased according to the condition and progres of the patient.