Simplified functional splinting after extensor tenorrhaphy

Abstract

The medical records of 22 patients who had a total of 61 simple or complex lacerations of finger, thumb, and wrist extensor tendons repaired in zones V-VIII (thumb zones TIII-TV) were reviewed. By 7 days after surgery, custom-molded splints were applied to hold the patients' wrists extended (approximately 30 degrees) and the metacarpophalangeal (MP) joints flexed slightly (20 degrees-30 degrees), leaving the interphalangeal (IP) joints free. If thumb tenorrhaphies were done, the thumb carpometacarpal and MP joints were included and splinted in neutral (0 degree extension) position. Patients performed active JP joint range of motion (ROM) exercises as instructed. At a mean follow-up period of 4.5 months (range, 1.5-12 months), there were no residual impairments that interfered with patients' activities of daily living or prevented their return to preinjury employment status; 19 of 22 patients (86%) had good or excellent results, based on objective criteria of active motion. There were no tenorrhaphy failures. The results support the concept of functional splinting techniques, which allow early active IP joint ROM while protecting the repaired tendons, thus resulting in less joint stiffness than older methods of static splinting without being as complicated and labor-intensive as dynamic splinting.