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Dynamic Versus Static Splinting of Simple Zone V and VI Extensor Tendon Repairs: A Prospective Randomized Controlled Study

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ABSTRACT

To date, published reports assessing postoperative rehabilitation outcomes have been limited to retrospective studies and prospective observations. The first prospective randomized controlled study comparing postoperative dynamic versus static splinting outcomes of patients following extensor tendon repair is presented.

Patients who incurred simple and complete lacerations of the extensor tendons in zones V and VI were enrolled in the study and underwent static splinting (n=17) or dynamic splinting (n=17) following primary acute tendon repair. Exclusion criteria included age <18 years, bony pathology (fractures or joint dislocations), significant overlying soft-tissue loss, noncompliance with therapy instructions, or failure to attend regular follow-up. Total active motion and grip strength were evaluated for outcome measures.

Total active motion improved in the dynamic group compared to the static group in the injured digits at 4 weeks (180.5º±45º versus 131.3º±61º; P=.006), 6 weeks (239º±21.9º versus 205.5º±53.4º; P=.048), and 8 weeks (247º±19.8º versus 216.3º±36º; P=.051), but not at 6 months (253.1º±18.8º versus 250.5º±32º; P=.562). Similarly, total active motion averaged for all digits (injured and noninjured) of the involved hand improved in the dynamic group over the static group at 4 weeks (209.8º±31.3º versus 140º±58.2º; P<.001), 6 weeks (241.5º±17.2º versus 217.1º±42.4º; P=.024), but not at 8 weeks (249.6º±16º versus 234.8º±24.5º; P=.215) or 6 months (252.3º±14º versus 249.1º±31º; P=.450).

Grip strength outcomes demonstrated improved grip force for the dynamic group compared to the static group at 8 weeks (81.3±18% versus 59.2±20.4%; P=.004) but not at 6 months (89.6±5.6% versus 82.1±22%; P=.595).

These findings suggest dynamic splinting of simple, complete lacerations of the extensor tendons in zones V and VI provides improved functional outcomes at 4, 6, and 8 weeks but not by 6 months when compared to static splinting. Therefore, dynamic splinting of simple, complete extensor tendon lacerations in zones V and VI is recommended only to select patients who are motivated and desire earlier return to full functional capacity.