RESUMEN
Rehabilitation after flexor tendon repairs is a challenging process. The repaired tendon must be simultaneously protected from disruption and moved in a controlled fashion to prevent restrictive adhesion formation. Although measures are necessary to protect the repaired structures, early controlled motion is required to enhance healing and function. Appropriate intervention at the correct phase of healing is based on an understanding of tendon healing and the factors that influence it. Coordination and communication between the surgeon and therapist is essential. Tendon injuries can profoundly affect hand function, and appropriate rehabilitation is essential to preserve function to the fullest extent possible.
Asunto(s)
Procedimientos de Cirugía Plástica , Traumatismos de los Tendones , Humanos , Traumatismos de los Tendones/cirugía , Tendones/cirugía , Cicatrización de Heridas , Adherencias Tisulares/prevención & control , Adherencias Tisulares/cirugíaRESUMEN
PURPOSE: Open fasciectomy represents a standard treatment of Dupuytren's disease. Although patients are commonly immobilized in extension to prevent postoperative contracture formation, immobilizing the extremity under tension may precipitate a flare reaction and scar-related complications. This study explores the incidence of flare reaction and other complications with postoperative tension-free splinting after fasciectomy for Dupuytren's contracture. METHODS: We retrospectively reviewed patients' charts that consisted of 228 procedures in 191 patients who underwent surgery by the senior author between 2000 and 2010. Postoperative notes were reviewed for wound healing problems, scar appearance, flare reaction, and complications. The grading system defined by Evans et al. was used to standardize flare reaction and scar complications. RESULTS: Using tension-free splinting, the incidence of flare reaction was 3.5 % (8/228). The eight patients that had flare reactions had mild involvement, and no severe reaction was observed. Fifteen patients had hypertrophic scars, eight had hypersensitive scars, and six had recurrent contractures. CONCLUSIONS: The incidence of flare reaction using tension-free immobilization postoperatively was low in our study. According to our findings, wound healing problems are rare when tensionless splinting is utilized. Type of study/level of evidence Case series, Level IV, Therapeutic study.
RESUMEN
PURPOSE: To determine the effect of a specific orthotic intervention and therapy protocol on proximal interphalangeal (PIP) joint contractures of greater than 40° caused by Dupuytren disease and treated with collagenase injections. METHODS: All patients with PIP joints contracted at least 40° by Dupuytren disease were prospectively invited to participate in the study. Following standard collagenase injection and cord rupture by a hand surgeon, a certified hand therapist evaluated and treated each patient based on a defined treatment protocol that consisted of orthotic intervention to address residual PIP joint contracture. In addition, exercises were initiated emphasizing reverse blocking for PIP joint extension and distal interphalangeal joint flexion exercises with the PIP joint held in extension to lengthen a frequently shortened oblique retinacular ligament. Patients were assessed before injection, immediately after injection, and 1 and 4 weeks later. There were 22 fingers in 21 patients. The mean age at treatment was 63 years (range, 37-80 y). RESULTS: The mean baseline passive PIP joint contracture was 56° (range, 40° to 80°). At cord rupture, the mean PIP joint contracture became 22° (range, 0° to 55°). One week after cord rupture and therapy, the contracture decreased further to a mean of 12° (range, 0° to 36°). By 4 weeks, the mean contracture was 7° (range, 0° to 35°). The differences in PIP joint contracture were statistically significant at all time points except when comparing the means at 1 week and 4 weeks. The results represent an 88% improvement of the PIP joint contracture. CONCLUSIONS: In the short term, it appears that severe PIP joint contractures benefit from specific, postinjection orthotic intervention and targeted exercises. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.