Dynamic splinting with early motion following zone IV/V and TI to TIII extensor tendon repairs

Abstract

Purpose: To investigate the influence of a dynamic splinting protocol on outcomes of extensor tendon repairs.

Methods: All patients in a prospectively collected database underwent extensor tendon repair by a single surgeon between 2004 and 2008. The inclusion criterion was simple extensor tendon repairs in zone IV and V in the fingers and zones TI to TIII in the thumb. The tendon repairs used a 4-strand core technique and running epitendinous suture. Within 7 days, each subject began using a dynamic extension splint during the day and a static extension splint at night. The extension splint allowed the patient to passively extend and actively flex the digits. After 3 weeks, the dynamic splint was discontinued and the patients were started on active digital motion. Static night splinting was continued for the next 3 weeks, after which time splinting was discontinued and strengthening was instituted. A total of 17 patients with 19 tendon lacerations met the inclusion criterion. There were 5 patients with lacerations of the thumb extensors and 12 patients with zone IV/V finger extensor tendon lacerations. The average time from injury to surgery was 11 days (range, 2-39 d). The follow-up was 43 to 215 days, with an average of 96 days.

Results: A total of 16 patients achieved good or excellent results by 6 weeks according to our grading system. One patient had a fair result. There were no ruptures and no tenolysis surgeries performed.

Conclusions: Dynamic splinting resulted in generally good functional outcomes for extensor tendon laceration repairs in zone IV/V and TI to TIII, without complications.

Type of study/level of evidence: Therapeutic IV.