Wyndell Merritt Immediate Controlled Active Motion (ICAM) Protocol following Extensor Tendon Repairs in Zone IV–VII: Review of Literature, Orthosis Design, and Case Study—A Multimedia Article

Abstract

Controlled post-operative motion of extensor tendon repairs in zones IV-VII is intended to facilitate tendon excursion and minimize adhesion formation. The Wyndell Merritt "relative motion" digital yoke orthosis provides a low-profile option allowing for immediate controlled active motion (ICAM) of the extensor tendon repair. The addition of a multimedia manuscript demonstrating the manufacturing of the Wyndell Merritt digital yoke orthosis may complement current literature on this topic. Two case studies demonstrating the use of the Wyndell Merritt ICAM digital yoke orthosis without wrist immobilization following zone V extensor tendon repair are presented. A literature review was completed. A video was produced highlighting fabrication of the digital yoke orthosis as well as video documentation of case study 1. Case study 1 demonstrated mild limitations in metacarpophalangeal (MP) flexion at 5-week follow-up that resolved by 6weeks. MP hyperextension was attainable for all digits at 5weeks. Grip strength was comparable to the contralateral uninjured hand at 10weeks. The second patient achieved normal composite flexion/extension by 4weeks. Attainment of normal hyperextension at the MP joints and grip strength for case study 2 was unknown, as the patient was lost to follow-up. The Wyndell Merritt ICAM digital yoke orthosis, fabricated with or without wrist immobilization, appears to facilitate the return of normal extensor tendon function after repair in zones IV through VII while minimizing morbidity to adjacent digits. This protocol provides a safe, low-profile, cost-effective alternative for post-operative treatment of zone IV-VII extensor tendon repairs.