Immobilization versus early active mobilization after surgical repair of injured extensor tendon of hand and forearm

Abstract

Background: Extensor tendon injuries are very common injuries in hand & forearm, which inappropriately treated can cause severe lasting impairment of hand function of the patient. After the extensor tendons repair whether to immobilization or to early active mobilization is debatable. Objectives: Compare the two common protocols, immobilization vs. early active mobilization by using a simple static splint after surgical repair of extensor tendon. Method: This prospective randomized study was conducted in the Department of Orthopaedic Surgery, BSMMU, Dhaka for duration of January 2014 to December 2017. Forty (40) patients of extensor tendon injuries in zone V-VIII were selected. The patients were divided into two groups by sealed envelope technique, Group A-immobilization group & Group B-early active mobilization group. Extensor tendon was repaired by Doyle proposed technique. Mayo Wrist Score and Dargan criteria were used for evaluation of final result at 12 th months. Results: Most of the patients were in 3 rd decade. Male and right hand injury were predominant in both groups. More than one third, (35.0%) patients were factory worker in immobilization group and 8(40.0%) in EAM group. Majority 17(85%) patients had glass cut injury in both groups. Nine (45.0%) patients had Zone VI injury in immobilization group and 10(50.0%) in EAM group. In immobilization group out of 72 tendon injury EDC injury was 37(51.38%) and in EAM group out of 69 tendon injury EDC injury was 37(53.62%). Complications developed 6(30.0%) in immobilization group and 4(20.0%) in EAM group. Satisfactory outcome was 85% in immobilization group and 95% in EAM group at 12 th months. Assessment at 12 th weeks and 6 th months were statistically significant (p<0.05) but not at 12 th months between two groups. Conclusion: EAM by using simple static splint following extensor tendon repair shown faster recovery, gain complete range of motion and improved grip strength at early post-operative period.

Functional Recovery Measurement: Comparing Early Active Mobilization Versus Immobilization after Extensor Tendon Repair in Zones IV to VIII

“…Previously, some authors documented the superiority of early active mobilization technique over the immobilization technique. 2,9,10 The most likely explanation of the difference in our findings is the improper compliance of the instructions given to patients who were treated with early active mobilization. Majority of the patients were illiterate and did not follow the teachings and thereby the outcomes effected.…”

“…10 The similar study was conducted in Bangladesh also reported that study participants belonged to age group of 21-30 years with male dominance. 2 Other international literature also reported that males were commonly affected by hand injuries. 11,12 Occupational injury was the most common mode of injury in our study.…”

“…Therefore, appropriate treatment is required to for optimized functioning of hand and returning to work earlier. 2 An approach to management is determined by the zone involved as each zone has the distinctive connection of anatomical elements and cross-sectional tendon size. 3 No matter whatsoever the level or type of injury, the surgeon is ultimately interested in protection of repair, modification of peritendinous adhesions, promoting tendon excursion and preserving joint motion.…”