Comparison of Treatment Outcomes of Different Immobilized Finger Positions After Repair of Flexor Tendon Rupture in Zones I and II: A Nonrandomized Controlled Trial With Historical Control Group

TL;DR

This study compares finger immobilization positions after tendon repair and finds that flexion fixation may lead to better outcomes than extension fixation.

Contribution

The study provides evidence that flexion fixation may be more effective than extension fixation for post-repair recovery of flexor tendon ruptures.

Findings

Flexion fixation resulted in significantly higher excellent Strickland ratings compared to extension fixation.

Flexion fixation showed better active flexion range of motion in the distal interphalangeal joint.

There was no significant difference in extension limitation angles between the two fixation groups.

Abstract

Introduction

The position of finger immobilization after flexor tendon rupture repair is changed to the extended position to prevent flexion contracture of the interphalangeal (IP) joint. However, in Strickland's assessment, We believe that a reduction in TAF (total active flexion) affects the outcome and that extension fixation is not necessarily the primary focus. For example, there are management methods that swap the fixed position between day and night. It is assumed that some effect is sought by placing the fingers in the flexed position. That is, the method of fixation is currently selected at individual facilities through twists and turns; however, the indications and criteria for selecting finger fixation positions are ambiguous, and they are apparently subject to the experience of therapists. This study aimed to characterize follow-up outcomes of flexion and extension fixation after zones I and II flexor tendon rupture repair.

Methods

This nonrandomized controlled trial with historical controls included 25 patients with flexor tendon ruptures of 30 fingers. The flexion fixation group consisted of 12 patients (n=16 fingers) and the extension fixation group consisted of 13 patients (n=14 fingers). The group with flexion fixation comprised patients who slept with their injured fingers in the flexed position (intervention group). The group with extension was retrospectively selected between April 2017 and March 2019, who slept with their injured finger in the extended position (historical control group). Strickland assessments of the range of motion (ROM) of each joint at the conclusion of hand therapy, the ratio of total active motion of the repaired, to the healthy finger (%TAF), and IP joint extension limitation angles were compared using Mann-Whitney U tests. Ratios of excellent and good ratings based on the Strickland assessment were compared using Fisher exact tests.

Result

The results of the Strickland assessment showed excellent or good outcomes for 22 (73%) of 30 fingers, which was in line with our previous findings. Strickland ratings of excellent were achieved in seven (44%) of 16 fingers and four (28%) of 14 fingers in the groups with flexion and extension fixation, respectively. The outcomes for two (22%) of 16 fingers and seven (78%) of 14 fingers in the groups with flexion and extension fixation were, respectively, rated as good. The proportion of patients rated as excellent was significantly higher in the group with flexion than extension fixation (p=0.040). The %TAF and the active flexion angle of the distal interphalangeal (DIP) joint were higher in the group with flexion than extension fixation (p=0008 and p=0.025, respectively). Furthermore, the total angle of the IP joint limit of extension did not significantly differ between the groups.

Conclusion

Flexion fixation after flexor tendon rupture achieved an excellent Strickland rating and was more effective than extension fixation, especially in terms of the active flexion ROM of the DIP joint. Flexion fixation might be an alternative to extension fixation because the range of flexion should be greater and might provide a range of finger extension motion equivalent to that of extension fixation.

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