Joachim Gülke1, Martin Mentzel2, Gert Krischak3, David Gulkin2, Daniel Dornacher4, Nikolaus Wachter5. 1. Zentrum für Chirurgie, Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinik Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland. joachim.guelke@uniklinik-ulm.de. 2. Zentrum für Chirurgie, Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinik Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland. 3. Institut für Rehabilitationsmedizinische Forschung, Universität Ulm, Am Kurpark 1, 88422, Bad Buchau, Deutschland. 4. Klinik für Orthopädie, Universitätsklinik Ulm, Oberer Eselsberg 45, 89081, Ulm, Deutschland. 5. Klinik für Hand‑, Plastische und Mikrochirurgie, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Deutschland.
Abstract
BACKGROUND: These days there are different types of aftercare following flexor tendon injury. Patients in this study received a dynamic Kleinert protocol and additionally two different postoperative treatments. Both treatment groups were compared to each other and results were put into perspective when compared to other treatment options. METHODS:Sixty-two patients presenting with clean lesions of the two flexor tendons in zone 2 receivedpostoperative treatment with a dynamic Kleinert protocol. Patients were randomly divided into either Group I (physical therapy) or Group II (exoskeleton). Range of motion was assessed after 6, 12 and 18 weeks. In addition, we measured the Strickland score and grip strength at the 18-week follow-up. DASH scores were obtained at weeks 12 and 18. RESULTS: Regardless of the received postoperative treatment, range of motion was predominantly limited in the proximal interphalangeal and distal interphalangeal joints after 6 weeks. This deficit decreased with time and almost full range of motion was achieved after 18 weeks. Grip strength measured 75% (Group I) and 78% (Group II) of the healthy hand's level. Good functional outcome was observed in the DASH scores after 12 weeks, which improved further, measuring 7.5 (Group I) and 6.8 (Group II) at the 18-week follow-up. We did not see any clinically relevant differences between the two patient groups. CONCLUSION: Regarding possible reruptures, the Kleinert protocol delivers a safe treatment regime. The possible disadvantage of flexion contractures with the Kleinert protocol was not seen in our measurements. Additional motion exercises using an exoskeleton delivered comparable results to classic physical therapy.
RCT Entities:
BACKGROUND: These days there are different types of aftercare following flexor tendon injury. Patients in this study received a dynamic Kleinert protocol and additionally two different postoperative treatments. Both treatment groups were compared to each other and results were put into perspective when compared to other treatment options. METHODS: Sixty-two patients presenting with clean lesions of the two flexor tendons in zone 2 received postoperative treatment with a dynamic Kleinert protocol. Patients were randomly divided into either Group I (physical therapy) or Group II (exoskeleton). Range of motion was assessed after 6, 12 and 18 weeks. In addition, we measured the Strickland score and grip strength at the 18-week follow-up. DASH scores were obtained at weeks 12 and 18. RESULTS: Regardless of the received postoperative treatment, range of motion was predominantly limited in the proximal interphalangeal and distal interphalangeal joints after 6 weeks. This deficit decreased with time and almost full range of motion was achieved after 18 weeks. Grip strength measured 75% (Group I) and 78% (Group II) of the healthy hand's level. Good functional outcome was observed in the DASH scores after 12 weeks, which improved further, measuring 7.5 (Group I) and 6.8 (Group II) at the 18-week follow-up. We did not see any clinically relevant differences between the two patient groups. CONCLUSION: Regarding possible reruptures, the Kleinert protocol delivers a safe treatment regime. The possible disadvantage of flexion contractures with the Kleinert protocol was not seen in our measurements. Additional motion exercises using an exoskeleton delivered comparable results to classic physical therapy.
Authors: Thomas E Trumble; Nicholas B Vedder; John G Seiler; Douglas P Hanel; Edward Diao; Sarah Pettrone Journal: J Bone Joint Surg Am Date: 2010-06 Impact factor: 5.284