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Year |
2001 |
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Question Number |
79. |
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Category |
Select |
Question
A 45-year-old man underwent a zone II flexor tendon repair. What type of splint will allow for the greatest safest excursion of the repaired tendons in the first 6 weeks?
1- Splint with continuous passive motion device
2- Static progressive splint
3 Dynamic splint
4- Dynamic splint with a palmar pulley
5- Dynamic splint with a hinge allowing for motion at the wrist
Figures
Answer (click for answer)
Answer-5 This is a pretty tough one. The splint with the hinge at the wrist is called a Mayo synergistics splint. The papers cited basically say it is the splint that allows the most tendon excursion safely in the early post-operative period for zone II injuries. The whole concept of flexor tendon reconstruction has evolved in the past forty years. These injuries were casted (no repair) long/long ago in an attempt to coapt the ends and allow healing. This changed to direct repair and immobilization while it healed. People did miserably from the stiffness and then early motion programs were developed. The big one was Kleinert who developed a program of active extension with assisted flexion from say a rubber band through the nail. The Mayo synergistic splint has active extension and coupled passive finger flexion and active wrist motion. The other program that is very common is one that utilizes active extension and patient assisted flexion (place and hold exercises). This is called the Duran program.
Reference: Horii E, Lin GT, Cooney WP, Linsheid RL, An KN:Comparative flexor tendon excursion after passive mobilization: An invitro study. J Hand Surg Am 1992; 17559-566.