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Rehabilitation regimens following surgical repair of extensor tendon injuries of the hand-a systematic review of controlled trials.

ABSTRACT: There is no consensus on the most effective rehabilitation regimen following extensor tendon repair of the hand. This systematic review evaluates the outcomes of the various regimens. The Cochrane, MEDLINE, EMBASE, CINAHL, AMED, PEDro, OTseeker databases were searched for any prospective randomised clinical trials comparing rehabilitation regimens for acute extensor tendon injuries in adults. Five papers met the inclusion criteria. The regimens were static immobilisation, dynamic splinting and early active motion (EAM). There was no standard format of reporting. The sample size ranged from 27 to 100 patients. The duration of follow-up ranged from 8 to 24 weeks. Overall, patients' total active motion improved with time. Early mobilisation regimens (active and passive) achieve quicker recovery of motion than static immobilisation but the long-term outcome appears similar. Given the comparable outcomes between dynamic splinting and EAM, we therefore favour EAM which is simpler and more convenient.

SUBMITTER: Ng CY

PROVIDER: S-EPMC3509285 | biostudies-literature | 2012 Dec

REPOSITORIES: biostudies-literature

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Rehabilitation regimens following surgical repair of extensor tendon injuries of the hand-a systematic review of controlled trials.

Ng Chye Yew CY Chalmer Joelle J Macdonald Duncan J M DJ Mehta Saurabh S SS Nuttall David D Watts Adam C AC

Journal of hand and microsurgery 20120915 2

There is no consensus on the most effective rehabilitation regimen following extensor tendon repair of the hand. This systematic review evaluates the outcomes of the various regimens. The Cochrane, MEDLINE, EMBASE, CINAHL, AMED, PEDro, OTseeker databases were searched for any prospective randomised clinical trials comparing rehabilitation regimens for acute extensor tendon injuries in adults. Five papers met the inclusion criteria. The regimens were static immobilisation, dynamic splinting and e ...[more]

PMID: 24293953

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Project description:Quality of life is enhanced by engagement in meaningful activities and participation using our hands. In African countries, people rely predominantly on the use of their hands to engage in economic productive activities, including agricultural, fishing, mining and construction, that are largely performed by machines in high-income contexts. Anecdotal evidence suggests a high incidence of flexor tendon injuries that are managed using protocols that were adopted from high-income countries and implemented without considering contextual differences. African therapists use discretion in selecting protocols thereby presenting inconsistency in tendon management. This result in challenges with ascertaining the most effective protocol, factors that influence protocols and the extent of evidence about flexor tendon rehabilitation in Africa. Therefore, this scoping review aims to provide evidence currently available on the rehabilitation of flexor tendons in African countries. This will synthesise the advantages and disadvantages of the current protocols and make proposals that are contextually relevant and cost-effective for rehabilitation of tendon injuries. METHODS AND ANALYSIS: The research will follow the scoping review methodological framework developed by Arksey and O'Malley (2005). The search strategy was developed and will be used to retrieve articles from eight databases. Further literature will be searched in the bibliography of the identified eligible articles. Grey literature will be searched in scientifically reliable websites, organisations and other sources. Articles will be reviewed by two independent researchers and opinion will be sought from a third reviewer when disagreement prevails on the inclusion quality of an article. All relevant articles that meet the criteria will be analysed using Weft QDA. ETHICS AND DISSEMINATION: The scoping review paper will be discussed with local therapists. Thereafter, findings will be published in the year 2021 and sent to rehabilitation associations in respective African countries.

Project description:BACKGROUND:While some traumatic closed index extensor tendon ruptures at the musclotendinous junction have been previously reported, closed index extensor tendon pseudorupture due to intertendinous attenuation is exceedingly rare with only one case report of a gymnastics-related sports injury in the English literature. Herein, we report two non-sports injury related cases of traumatic index extensor tendon attenuation mimicking closed tendon rupture, including the pathological findings and intraoperative video of the attenuated extensor indicis proprius tendon. CASE PRESENTATION:A 28-year-old man and a 30-year-old man caught their hands in a high-speed drill and lathe, respectively, which caused a sudden forced flexion of their wrists. They could not actively extend the metacarpophalangeal joints of their index fingers. Intraoperatively, although the extensor indicis proprius and index extensor digitorum communes tendons were in continuity without ruptures, both tendons were attenuated and stretched. The attenuated index extensor tendons were reconstructed either with shortening by plication or step-cut when the tendon damage was less severe or, in severely attenuated tendons, with tendon grafting (ipsilateral palmaris longus) or tendon transfer. Six months after the operation, the active extension of the index metacarpophalangeal joints had recovered well. CONCLUSIONS:Two cases of traumatic index extensor tendon attenuation were treated successfully by shortening the attenuated tendon in combination with tendon graft or transfer. We recommend WALANT (wide-awake local anesthesia and no tourniquet) in the reconstruction surgery of index extensor tendon attenuation to determine the appropriate amount of tendon shortening or optimal tension for tendon grafting or transfer. Intraoperative voluntary finger movement is essential, as it is otherwise difficult to judge the stretch length of intratendinous elongation and extent of traumatic intramuscular damage affecting tendon excursion.

Project description:The spleen is often removed in laparotomy after traumatic abdominal injury, with little effort made to preserve the spleen. To explore the association of surgical management (splenic repair vs splenectomy) with outcomes in patients with traumatic splenic injuries undergoing laparotomy and to determine whether splenic repair is associated with lower mortality compared with splenectomy. This is a trauma registry-based cohort study using the American College of Surgeons Trauma Quality Improvement Program database from January 2013 to December 2019. Participants included adult patients with severe splenic injuries (Abbreviated Injury Scale [AIS] grades 3-5) undergoing laparotomy after traumatic injury within 6 hours of admission. Data analysis was performed from April to August 2023. Splenic repair vs splenectomy in patients with severe traumatic splenic injury. The primary outcome was in-hospital mortality. Outcomes were compared using different statistical approaches, including 1:1 exact matching with consecutive conditional logistic regression analysis as the primary analysis and multivariable logistic regression, propensity score matching, and inverse-probability weighting as sensitivity analyses. A total of 11 247 patients (median [IQR] age, 35 [24-52] years; 8179 men [72.7%]) with a severe traumatic splenic injury undergoing laparotomy were identified. Of these, 10 820 patients (96.2%) underwent splenectomy, and 427 (3.8%) underwent splenic repair. Among patients who underwent an initial splenic salvage procedure, 23 (5.3%) required a splenectomy during the subsequent hospital stay; 400 patients with splenic preservation were matched with 400 patients who underwent splenectomy (matched for age, sex, hypotension, trauma mechanism, AIS spleen grade, and AIS groups [0-2, 3, and 4-5] for head, face, neck, thorax, spine, and lower and upper extremity). Mortality was significantly lower in the splenic repair group vs the splenectomy group (26 patients [6.5%] vs 51 patients [12.8%]). The association of splenic repair with lower mortality was subsequently verified by conditional regression analysis (adjusted odds ratio, 0.4; 95% CI, 0.2-0.9; P = .03). Multivariable logistic regression, propensity score matching, and inverse-probability weighting confirmed this association. In this retrospective cohort study, splenic repair was independently associated with lower mortality compared with splenectomy during laparotomy after traumatic splenic injury. These findings suggest that efforts to preserve the spleen might be indicated in selected cases of severe splenic injuries.

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Rehabilitation regimens following surgical repair of extensor tendon injuries of the hand-a systematic review of controlled trials.

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Rehabilitation regimens following surgical repair of extensor tendon injuries of the hand-a systematic review of controlled trials.

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