Dynamic versus Static Splinting of Simple Zone V and Zone VI Extensor Tendon Repairs: A Prospective, Randomized, Controlled Study

Abstract

The authors present the first prospective, randomized, controlled study comparing postoperative dynamic versus static splinting outcomes of patients following extensor tendon repair. Patients who incurred simple and complete lacerations of their extensor tendons in zones V and VI were enrolled into the study and underwent either static splinting (n = 17) or dynamic splinting (n = 17) following primary acute repair of tendons. Total active motion was improved in the dynamic group when compared with the static group in the injured digits at 4 weeks (180.5 +/- 4 degrees versus 131.3 +/- 61 degrees; p = 0.006), at 6 weeks (239 +/- 21.9 degrees versus 205.5 +/- 53.4 degrees; p = 0.048), and at 8 weeks (247+/- 19.8 degrees versus 216.3 +/- 36 degrees; p = 0.051), but not at 6 months (253.1 +/-18.8 degrees versus 250.5 +/- 32 degrees; p = 0.562). Similarly, total active motion averaged for all digits (injured and noninjured) of the involved hand was improved in the dynamic group over the static group at 4 weeks (209.8 +/- 31.3 degrees versus 140 +/- 58.2 degrees; p < 0.001) and at 6 weeks (241.5 +/- 17.2 degrees versus 217.1 +/- 42.4 degrees; p = 0.024), but not at 8 weeks (249.6 +/- 16 degrees versus 234.8 +/- 24.5 degrees; p = 0.215) or 6 months (252.3 +/- 14 degrees versus 249.1 +/- 31 degrees; p = 0.450). Grip strength outcomes demonstrated improved grip force for the dynamic group when compared with the static group at 8 weeks (81.3 +/- 18.0 percent versus 59.2 +/- 20.4 percent; p = 0.004) but not at 6 months (89.6 +/- 5.6 percent versus 82.1 +/- 22.0 percent; p = 0.595). Patients demonstrated forceful grip greater than or equal to 80 percent of the noninjured hand in 55 percent of patients in the dynamic group versus 15 percent of patients in the static group at 8 weeks. Patients demonstrated forceful grip greater than or equal to 80 percent of the noninjured hand in 100 percent of patients in the dynamic group versus 73 percent of patients in the static group at 6 months. The authors' findings suggest that dynamic splinting of simple, complete lacerations of the extensor tendons in zones V and VI provides improved functional outcomes at 4, 6, and 8 weeks but not by 6 months when compared with static splinting. Therefore, they recommend dynamic splinting of simple, complete extensor tendon lacerations in zones V and VI only to select patients who are motivated and desire earlier return to full functional capacity.

The optimal orthosis and motion protocol for extensor tendon injury in zones IV-VIII: A systematic review

“…Early total active motion (4–6 weeks) was greater with dynamic extension orthoses (191–214°) and relative motion orthoses (205–236°) compared to static orthoses (79–202°), though three studies found that there was no difference in long-term follow-up. 9,31,32 Grip strength was not as reliably measured in all studies, but, those that did measure it, found greater improvement in the EAM patients than those treated statically (DEO 35–38 kg/89% contralateral side; RMO 85–95% contralateral side; static 23–34 kg/59% contralateral side). 9–11,21,30,31,34 The timing of return to work was not reported all studies, but in three studies investigating a specific EAM protocol – the immediate relative motion protocols (IRAM) using the RMO – patients returned to light duties at work around 3 weeks postoperative (3.2–3.9) compared to 9.4 weeks for static orthoses.…”

“…9,31,32 Grip strength was not as reliably measured in all studies, but, those that did measure it, found greater improvement in the EAM patients than those treated statically (DEO 35–38 kg/89% contralateral side; RMO 85–95% contralateral side; static 23–34 kg/59% contralateral side). 9–11,21,30,31,34 The timing of return to work was not reported all studies, but in three studies investigating a specific EAM protocol – the immediate relative motion protocols (IRAM) using the RMO – patients returned to light duties at work around 3 weeks postoperative (3.2–3.9) compared to 9.4 weeks for static orthoses. 10,33,34 Only one study 28 (of 100 subjects) experienced tendon ruptures, with one in the EAM group and 2 in the dynamic extension orthosis group.…”

Extensor Tendon Injuries

“…25 They found significantly better total active motion (TAM) and grip strength in the early dynamic mobilization group at 8 weeks (p ϭ .05) but no difference at 6 months. The authors recommended early dynamic mobilization for highly motivated and compliant patients, but warned of increased risk of complications such as extensor tendon rupture and extensor lag.…”

Management of Complications of Extensor Tendon Injuries

“…[19][20][21] Immobilization of the wrist and metacarpophalangeal joints Immobilization following simple zone V and VI extensor tendon repairs has been shown to produce excellent outcomes at 6 months after repair. 22 However, in complex injuries with multiple tendon involvement and/or metacarpal fractures, immobilization produces dense adhesion formation, which limits active and passive tendon glide during both digital flexion and extension. Immobilization should be reserved for noncompliant patients or children.…”