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Outcomes at 3 Months of a Place and Active Hold Method of Flexor Tendon Rehabilitation Following Zone Ii Injury Publisher Pubmed



Farzad M1, 2 ; Abdolrazaghi H3 ; Smaeel Beygi A4 ; Shafiee E1 ; Macdermid JC1 ; Layeghi F4
Authors
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Authors Affiliations
  1. 1. School of Physical Therapy, University of Western Ontario, Roth McFarlane Hand and Upper Limb Centre, London, ON, Canada
  2. 2. Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
  3. 3. Department Hand and Reconstructive Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

Source: Journal of Hand Surgery Asian-Pacific Volume Published:2022


Abstract

Background: Previous studies have shown that outcomes following a place and active hold (PAH) are better than a passive flexion protocol after a two-strand core-suture repair of flexor tendons injuries in zone II. This study aims to determine the outcomes of a PAH protocol of flexor tendon rehabilitation following a four-strand core-suture plus an epitendinous suture repair of the flexor digitorum profundus (FDP) combined with a simple horizontal loop repair of the flexor digitorum superficialis (FDS). Methods: This is a prospective study of patients with complete injury to both flexor tendons in zone II. All tendons were repaired with a simple horizontal loop for FDS and four-strand core-suture plus epitendinous suture for FDP. The PAH protocol was used postoperatively for 6 weeks. The outcome was evaluated using flexion contracture and total active motion (TAM), interpreted using Strickland criteria and categorised as excellent, good, fair and poor at 6 weeks and 3 months. The linear regression model was used to determine predictors of outcomes. Results: The study included 32 patients with flexor tendon injury in 46 fingers. No repairs ruptured, and 24 (52%) digits achieved good or excellent motion 6 weeks after surgery using the Strickland criteria. According to the Strickland criteria, 41 (89%) digits ranked as excellent and good with no poor result at a 3-month follow-up. Four patients had 5-10° of flexion contracture. Age was the predictor of TAM at 6 weeks and accounted for 13% of its variation. Improvement of TAM from 6 weeks to 3 months was related to age and flexion contracture at 6 weeks. Conclusions: The PAH protocol can be considered a safe technique for flexor rehabilitation after four-strand core-suture repair of FDP in zone II. Level of Evidence: Level IV (Therapeutic). © 2022 Asian-Pacific Federation of Societies for Surgery of the Hand.