The Manchester short splint: A change to splinting practice in the rehabilitation of zone II flexor tendon repairs

Abstract

Introduction: The results of patients with primary zone II flexor tendon repairs rehabilitated using a traditional forearm-based splint were audited and compared with those who were managed in the Manchester short splint. Method: The short splint was fabricated to permit maximal wrist flexion and up to 45 of wrist extension with a block to 30 of metacarpophalangeal joint extension. A rehabilitation regimen consisting of early combined passive flexion exercises and active motion was employed. In 2011, 62 patients (76 digits) with a mean age of 34 years (range 14-58) were rehabilitated using the forearm-based splint (group A). In 2012, 40 patients (45 digits) with a mean age of 31 years (range 15-71) were rehabilitated using the Manchester short splint (group B). Results: Group B had significantly less flexion contracture at their proximal interphalangeal joints than group A at 6 weeks (median 15 versus 28 ; p ¼ 0.003) and 12 weeks (median 6 versus 18 ; p ¼ 0.024) postoperatively. At the final review, group B had a significantly greater arc of flexion at their distal interphalangeal joints (median 59 versus 30 ; p < 0.001) and a greater proportion of patients with excellent/good Strickland's grades. There were three (3.9%) ruptures in group A and two (4.4%) ruptures in group B (p > 0.999). Conclusion: The use of a shorter splint would appear to enhance the outcomes whilst preserving repair integrity.

Rehabilitation of the Upper Extremity Following Nerve and Tendon Reconstruction: When and How

“…[60][61][62][63] This configuration allows the benefits of synergistic motion while avoiding the complicated fabrication of a dynamic orthosis. The least complicated and most progressive regimen that has been introduced is the Manchester short splint 64 : a hand-based dorsal block with the MPs positioned in 30-degree flexion. Compared with a historical control group treated in a wrist neutral position, patients treated with the short splint demonstrated significantly less flexion contractures, and greater DIP flexion, and were more likely to achieve excellent/good results.…”

“…Compared with a historical control group treated in a wrist neutral position, patients treated with the short splint demonstrated significantly less flexion contractures, and greater DIP flexion, and were more likely to achieve excellent/good results. 64 Based on this literature, protective immobilization following flexor tendon repair appears to be moving away from the traditional position of wrist flexion. Complex, dynamic orthoses allowing wrist extension have evolved to a simpler static dorsal block positioned in wrist extension, and the question of whether to immobilize the wrist at all remains to be answered.…”

“…The concept of true early active motion is often credited to the Belfast Protocol 72 and has evolved with modifications to wrist position and varying degrees of digital motion. [60][61][62][63][64]73 Preceded by passive motion "warm up," Tang 73 advocates a flexed wrist position with active motion progressed through the first two-thirds of full range of digital motion-avoiding the higher levels of anatomical resistance in the final third. This conservative wrist position is maintained for the first 2½ weeks while the patient focuses on full extension to the dorsal block as opposed to composite flexion.…”

“…57 Certainly the most progressive approach is the Manchester Short Splint. 64 Active motion of the digits within the first third of the range is paired with active wrist extension up to 45 degrees. In this approach, 64 there is a focus on initiation of DIP joint motion to maximize differential tendon glide.…”

Efficacy of the Manchester Short Splint versus traditional dorsal splint for rehabilitation of Zone II flexor tendon repairs: study protocol for a randomized controlled trial

“…Traditional hand therapy is based on using a long dorsally forearm-based splint for 6 weeks in the zone II exor tendon injuries (1)(2)(3)(4). A novel shorter splint has been devised as an alternative to the traditional longer splint and we have previously reported on the same providing preliminary observational data supporting the safety and e cacy of the short splint in clinical use (5).…”