Post Op Care: Zone II Injuries : Wheeless' Textbook of Orthopaedics

- Discussion:
- initial postop plaster splint holds wrist in 20 deg flexion, MP joints in at least 60 deg flexion, and digits should be held in extension in order to avoid contractures;
- early motion is started to decrease tendon adhesions & to improve digit motion;
- patients are assisted w/ passive flexion and extension exercises which are directed independently to the DIP and the PIP joints;
- adhesions form if part is immobilized because the wound in sheath and wound in the tendon grow together;
- if part is kept mobile, they heal separately, and function is more likely to be restored;
- collagen tensile strength across the repair is not sufficient to permit active loading for 4-5 weeks;

- Types of Splints:
- Chow Splint:
- moves the rubber band insertion from the distal radius region (Kleinert) to the palm;
- this increases digital flexion, and maximizes differential tendon excursion between the FDS and FDP;
- Kleinert Splint:
- combines dorsal extension block w/ rubber-band traction proximal to wrist;
- originally, included a nylon loop placed thru the nail, and around the nail is placed a rubber band;
- rubber band is inserted into the dressing (via paper clip), over distal radius;
- this passively flexes fingers, & pt actively extends w/ in limits of the splint;
- originally, rubber bands were applied for only 1-2 hrs / day, in order to avoid finger flexion contractures;
- Brooke Army Hospital Splint:
- uses rubber-band traction to passively flex fingers, but traction is through pulley at distal palmar crease, which increases passive flexion at IP joints;
- during active extension exercises, pt is instructed to hold MP joint in flexed position and then to extend fully IP joints;
- full excursion of IP joints is obtained while tendon is protected