Introduction There is a lack of evidence on the best method for rehabilitating extensor tendon injuries in zones V and VI. The purpose of this study was to evaluate the outcomes of modified relative motion splinting compared with immobilization following repair of extensor tendons in zones V and VI. Methods A retrospective analysis compared the outcomes of relative motion splinting with immobilization. Sixteen patients (16 fingers) were treated by conventional immobilization splinting for four weeks (immobilization group) followed by mobilization with avoidance of ‘at-risk/heavy’ activities for a further 4–6 weeks. Twenty-three patients (23 fingers) were treated with the modified relative motion splint (mRMS group) during the day and a resting splint worn overnight for the first four weeks. The relative motion splint was continued for ‘at-risk/heavy’ activities for a further 4–6 weeks. Results The mRMS group demonstrated statistically significant improvement in range of motion compared with the immobilization group. This effect was most marked at six weeks ( P = 0.0194, two-way mixed ANOVA) with the mRMS group achieving a 12% higher mean percentage total active motion ( P = 0.0076, Mann-Whitney U test). Results were similar for both groups 12 weeks postoperatively. Differences in return to work times between groups were statistically significant ( P = 0.0062, Mann-Whitney U test). Average return to work was 9.4 weeks for the immobilization group and 3.3 weeks for the mRMS group, equating to a 42 days earlier return to work for the mRMS group. There was no incidence of tendon rupture in either group. Conclusion This study demonstrates that modified relative motion splintage (finger based without wrist component) can be applied in the postoperative management of single zone V or VI extensor tendon repairs. The main advantages of this protocol, compared with immobilization include the small simple splint design, and straightforward patient instructions that enable earlier mobilization, functional hand use and return to both daily living and work.
Introduction
Acute intra-articular fractures of the proximal interphalangeal joint have always presented as a difficult injury to manage for the treating surgeon and therapist. Traction management enabling ligamentotaxis and motion is a popular method to manage these injuries. This case series presents the design and results of hand-based swing traction splinting which is less cumbersome for patients than other forms of traction splinting.
Methods
Five patients presenting with intra-articular proximal interphalangeal joint fractures underwent surgery whereby a transverse K-wire was inserted across the middle phalanx. The treating Occupational Therapist fabricated a hand-based swing traction splint to provide a distraction force from the K-wire to the splint. Range of motion and patient satisfaction were the primary outcome measures.
Results
All five patients reported satisfaction with their hand function following therapy involving swing traction splinting. Furthermore, range of motion was comparable to other forms of traction management reported in the literature with an 88° mean arc of motion at the proximal interphalangeal joint.
Conclusion
This case series demonstrates that hand-based swing traction splinting is a viable treatment option for the management of intra-articular proximal interphalangeal joint fractures. With similar outcomes to other forms of distraction that enable early movement, such as the pins and rubber traction system, this design is an alternative. The less cumbersome splint design is the main advantage over other splinting methods that apply distraction whilst also enabling early motion.
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