Closed treatment of nonrheumatoid extensor tendon dislocations at the metacarpophalangeal joint.

PURPOSE: Acute sagittal band injuries at the metacarpophalangeal (MCP) joint resulting in subluxation or dislocation of the extensor tendons may cause pain and swelling at the MCP joint and limit active extension of the MCP joint. These injuries often are treated with surgical repair or reconstruction. This article outlines a nonsurgical treatment protocol that uses a customized splint for acute, nonrheumatoid extensor tendon dislocations caused by injury to the sagittal bands. METHODS: We retrospectively reviewed 10 patients with 11 acute sagittal band injuries who were treated with a splint of thermally molded plastic that differentially holds the injured MCP joint in 25 degrees to 35 degrees of hyperextension relative to the adjacent MCP joints. All the sagittal band ruptures resulted in complete dislocation of the extensor digitorum communis (EDC) tendon-Rayan and Murray type III injuries. Active proximal interphalangeal and distal interphalangeal motion was begun immediately at the time of initial splinting. The average follow-up period was 14 months. RESULTS: At the time of final evaluation all patients had full range of motion in flexion and extension. Eight patients had no pain and 3 had moderate pain. Four patients (5 digits) had no extensor tendon subluxations and 3 had barely discernable subluxations. Three patients had moderate subluxation of the EDC tendon and their treatments were considered failures. One of these patients had subsequent sagittal band reconstruction. CONCLUSIONS: Our results show acute sagittal band injuries in nonrheumatoid patients resulting in dislocation of the EDC tendon can be managed nonsurgically in many patients with a customized splint called the sagittal band bridge. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Limited, protected postsurgical motion does not affect the results of digital nerve repair.

PURPOSE: Casting for 3 to 4 weeks has been the accepted protocol after primary repair of digital nerve lacerations. In contrast, combined digital nerve and flexor tendon repairs are rehabilitated with immediate postsurgical range of motion. The purpose of this study was to compare the results of primary nerve repair in isolated digital nerve lacerations immobilized after surgery with nerve repairs combined with flexor tendon repairs that are mobilized in a limited, protected fashion immediately after surgery. METHODS: We reviewed retrospectively patients who had had surgical repair of isolated digital nerve lacerations or combined digital nerve and flexor tendon lacerations. Demographics recorded included age, hand dominance, injured digit, and time to mobilization. Follow-up data included range of motion at the metacarpophalangeal, proximal interphalangeal, distal interphalangeal, and wrist joints; static 2-point discrimination; and Semmes-Weinstein monofilament testing. Between-group comparisons were based on t-tests for continuous measures and chi-square tests for categoric measures. Paired t-tests were used for within-group comparisons. All comparisons were based on 2-tailed.05-level tests. RESULTS: Fourteen patients (16 digits) with isolated nerve repairs (group 1) and 12 patients (14 digits) with combined nerve and tendon repairs (group 2) were evaluated. The average age and duration at follow-up evaluation were similar in the 2 groups. The average time to mobilization, however, was 21 days in group 1 and 4 days in group 2. Injuries occurred equally in dominant and nondominant hands. Good range of motion returned in all digits. In addition there was no significant difference in final 2-point discrimination and Semmes-Weinstein testing between groups 1 and 2. CONCLUSIONS: Our data showed a decrease in sensibility between the injured and uninjured digits in each of the 2 groups studied, as has been shown previously. The difference in sensibility between the 2 groups, however, was not statistically significant. These data challenge the long-held belief that digital nerve repairs should be completely immobilized after surgery.