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Post Op Care: Zone II Injuries


- Discussion:
     - initial postop plaster splint holds wrist in 20 deg flexion, MP joints in at least 60 deg flexion, and digits should be held in
               extension in order to avoid contractures;
     - early motion is started to decrease tendon adhesions & to improve digit motion;
     - patients are assisted w/ passive flexion and extension exercises which are directed independently to the DIP and the PIP joints;
     - adhesions form if part is immobilized because the wound in sheath and wound in the tendon grow together;
           - if part is kept mobile, they heal separately, and function is more likely to be restored;
           - collagen tensile strength across the repair is not sufficient to permit active loading for 4-5 weeks;

- Types of Splints:
     - Chow Splint:
          - moves the rubber band insertion from the distal radius region (Kleinert) to the palm;
          - this increases digital flexion, and maximizes differential tendon excursion between the FDS and FDP;
     - Kleinert Splint:
          - combines dorsal extension block w/ rubber-band traction proximal to wrist;
          - originally, included a nylon loop placed thru the nail, and around the nail is placed a rubber band;
          - rubber band is inserted into the dressing (via paper clip), over distal radius;
          - this passively flexes fingers, & pt actively extends w/ in limits of the splint;
          - originally, rubber bands were applied for only 1-2 hrs / day, in order to avoid finger flexion contractures;
     - Brooke Army Hospital Splint:
          - uses rubber-band traction to passively flex fingers, but traction is through pulley at distal palmar crease, which increases
                passive flexion at IP joints;
          - during active extension exercises, pt is instructed to hold MP joint in flexed position and then to extend fully IP joints;
                 - full excursion of IP joints is obtained while tendon is protected

  Active Place and Hold Therapy



Elastic band mobilisation after flexor tendon repair; splint design and risk of flexion contracture.

Improved results in zone 2 flexor tendon injuries with a modified technique of immediate controlled mobilization.

Influences of the protected passive mobilization interval on flexor tendon healing. A prospective randomized clinical study.

Effect of synergistic wrist motion on adhesion formation after repair of partial flexor digitorum profundus tendon lacerations in a canine model in vivo.

Effect of synergistic motion on flexor digitorum profundus tendon excursion

Immediate active mobilisation after flexor tendon repairs in Verdan's zones I and II. A prospective study of 20 cases.

Zone-II Flexor Tendon Repair: A Randomized Prospective Trial of Active Place-and-Hold Therapy Compared with Passive Motion Therapy

Flexor digitorum profundus tendon excursions during controlled motion after flexor tendon repair in zone II: a prospective clinical study

Gap formation during controlled motion after flexor tendon repair in zone II: a prospective clinical study

Controlled mobilization after flexor tendon repair in zone II: a prospective comparison of three methods

Improved results in zone 2 flexor tendon injuries with a modified technique of immediate controlled mobilization

Year Book: Early Active Mobilisation Following Flexor Tendon Repair in Zone 2

Measurement of range of motion of the finger after flexor tendon repair in zone II of the hand

The correlation between controlled range of motion with dynamic traction and results after flexor tendon repair in zone II

Further experience in rehabilitation of zone II flexor tendon repair with dynamic traction splinting.