Early Controlled Motion with Dynamic Splinting versus Static Splinting for Zones III and IV Extensor Tendon Lacerations: A Preliminary Report

Abstract

Recent developments in the understanding of tendon healing and the effects of early motion have led to early controlled motion programs (ECM) for lacerated extensor tendons. The purpose of this study was to determine whether there were differences in length of treatment and final results when patients who had been treated with ECM with dynamic splinting were compared with patients who had been treated with traditional static extension splinting (SES) for zone III and zone IV extensor tendon lacerations. A retrospective study of patient charts from June 1984 through January 1990 was conducted. A total of 36 charts were reviewed. Twenty-seven patients met the study criteria: treatment with ECM with dynamic splinting (n = 10) and treatment with traditional SES using a finger-hand splint (n = 17). Data were analyzed for total number of therapy visits (V), total number of weeks of therapy before discharge (W), total active motion achieved (TAM), total passive motion achieved (TPM), and incidence of complications. Significance was established at the p = 0.05 level for all statistical analyses. There were no significant differences between the groups for V (t =1.76, p = 0.09), W (t = 0.58, p = 0.57), TPM (t = 0.12, p = 0.90), TAM (t = 0.44, p = 0.66), or the incidence of extensor lag (X2 = 2.264). The Cohen stat power analysis value was 0.40, revealing that the number of patients was too small for significance. The earlier return to work in the ECM group did not result in a greater extensor lag or a difference in TPM or TAM. The differences in V and W, although not statistically significant, may represent a way to control the cost of care. A larger sample is needed to determine whether ECM with dynamic splinting is indeed successful in significantly reducing rehabilitation time without sacrificing proximal interphalangeal (PIP) joint extension, TAM, or TPM.