Silfverskiold technique combined with dynamic splinting for treatment of digital extensor tendon rupture in zones III and IV

Abstract

Objective To investigate the clinical results of Silfverskiold suture combined with dynamic splinting in treating extensor digitorum tendon rupture in zones Ⅲ and Ⅳ. Methods Between March 2010 and October 2013, a total of 67 patients with 85 extensor digitorum tendon lacerations in zones Ⅲ and Ⅳ were included in this study. The tendons were repaired using Silfverskiold technique which was a combination of modified Kessler core suture and running cross-stitch epitendinous suture. The patients began controlled exercise within seven days postoperatively wearing a dynamic extension splint. Active flexion and passive extension of the fingers were repeated ten times per hour. After three weeks, the dynamic splint was removed and the patients began active finger flexion and extension. Protective static splinting was continued with the interphalangeal joints in full extension between exercises and during the night for another 2 weeks. Results Postoperative follow-up period ranged from 3 to 6 months, with an average of 4 months. Forty-two of the 67 patients regained full range of motion within 9 weeks postoperatively. At the final follow-up evaluation, according to Miller′s criteria, the results were graded as excellent in 50 fingers, good in 30 fingers and fair in 5 fingers. The overall satisfactory rate was 94.1%. There was no rupture of the repaired tendons. Conclusion Silfverskiold suture combined with dynamic splinting is an effective treatment method for extensor digitorum tendon lacerations in zones Ⅲ and Ⅳ. It is safe and reliable. Key words: Tendon injuries; Rehabilitation; Silfverskiold technique; Dynamic splinting