Use of a relative motion flexion orthosis after epitendinous zone II flexor tendon repair: A case report.

STUDY DESIGN: Case report INTRODUCTION: Relative motion flexion (RMF) orthoses are emerging as an option for early active motion (EAM) postoperatively. PURPOSE OF THE STUDY: To describe the rationale and implementation of an RMF orthosis to manage a patient after partial zone II epitendinous flexor tendon repairs. METHODS: This case involves a female who sustained partial flexor tendon lacerations to her middle finger in zone II, 60% flexor digitorum superficialis (FDS) and 90% flexor digitorum profundus (FDP). After epitendinous repair she was referred to therapy for EAM with a no orthosis request. The unusual circumstances prompted the therapist, concerned about the risk of tendon rupture to engage in discussion with the surgeon. Following discussion, a decision was made to use an RMF orthosis for controlled EAM to protect the epitendinous zone II FDS and FDP repairs. Outcomes of range of motion (ROM), total active motion (TAM), %TAM, grip, and quickDASH are reported. RESULTS: Neither the FDP or FDS tendons ruptured, nor were there any joint contractures. "Good" %TAM outcomes were achieved at 12-week postoperatively. Quick DASH scores improved 61 points indicating a clinically meaningful difference of improved function. DISCUSSION: The lack of a multi-strand core suture repair is unusual in combination with EAM. The positive outcomes reported in this single patient have raised questions about the protective benefit of the RMF orthosis when used with a zone II epitendinous repair of a 90% FDP laceration. Epitendinous repair of a partial (60%) FDS injury, however, is not uncommon and often not repaired at all. CONCLUSIONS: In this single case report the epitendinous repairs of zone II 90% FDP and 60% FDS with digital nerve involvement were successfully managed with an RMF only orthosis. The use of EAM with an epitendinous repair is in conflict to the current surgical and therapy literature.

Conservative interventions for treating hyperextension injuries of the proximal interphalangeal joints of the fingers.

BACKGROUND: Immobilisation and early motion (protected or unrestricted) are both used following hyperextension injuries to the proximal interphalangeal (PIP) joint of the finger. OBJECTIVES: To assess the effects of conservative interventions (non-surgical management) for treating hyperextension injuries of the proximal interphalangeal joints of the fingers. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2012), the Cochrane Central Register of Controlled Trials (in The Cochrane Library 2012, Issue 1), MEDLINE (1946 to January Week 2 2012), EMBASE (1980 to 2012 Week 03), CINAHL (1950 to 24 January 2012), PEDro (1929 to March 2012), trial registers and reference lists of articles. SELECTION CRITERIA: Randomised and quasi-randomised studies comparing immobilisation/protected mobilisation/unrestricted mobilisation in participants with PIP joint hyperextension injuries managed non-surgically. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed risk of bias and extracted data. There was no pooling of data. MAIN RESULTS: Three trials involving 366 people were identified. All three trials, which were over 15 years old, were methodologically flawed with unclear or high risk of bias. None of the studies reported on self assessment of function. One trial compared unrestricted mobility with immobilisation; one trial compared protected mobilisation with immobilisation; and the remaining trial compared immobilisation for one week versus three weeks. None of these trials found statistically significant differences between their intervention groups in various measures of poor outcome, pain and range of movement at six months follow-up. This lack of difference applied at three years for the comparison between unrestricted mobility with immobilisation. AUTHORS' CONCLUSIONS: There is insufficient evidence from trials testing the need for, and the extent and duration of, immobilisation to inform on the key conservative management decisions for treating hyperextension injuries of the proximal interphalangeal joints.