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Background: The principle of relative motion has allowed patients to regain a higher degree of hand function, while protecting extensor tendon repairs. The purpose of this study was to determine whether the principle of relative motion could be a viable method to protect a flexor tendon repair., Methods: Four fresh-frozen cadaver arms were each mounted on a testing apparatus (wrist in 30° of extension, metacarpophalangeal [MCP] joints blocked to 70°-80°). A minimum of 11 N was used to cyclically load the flexor digitorum profundus and extensor digitorum communis tendons to maximum allowable flexion and extension for 25 cycles. Measurements of elongation of the tendons were obtained through the use of differential variable reluctance transducers. Testing was performed in both intact and repaired (single 6-0 nylon suture) middle finger tendons (zone 3) with and without a relative motion flexion splint (RMFS), which placed the affected finger in 15° to 25° of relative flexion at the MCP joint., Results: In all 4 hands, elongation was restricted to less than 1.3 mm in repaired tendon in the RMFS compared with elongation >2 mm in the nonsplinted condition. Average elongation was 0.86 mm (SD = 0.45). Visual examination of the tendons demonstrated no gapping with the use of the RMFS in any of the hands. All repairs had suture breakage and repair rupture without the RMFS., Conclusions: This study demonstrates that the RMFS decreases elongation and eliminates tendon-repair gapping after flexion/extension cycling in a cadaver model. It provides proof of concept that the RMFS may be a viable protective mechanism for flexor tendon repairs in zone 3.

Flexor tendon lacerations still represent a challenging problem for the hand and the plastic surgeon, particularly in zone II. Many techniques have been devised accordingly to make the surgery of this zone easier. Hence, we too have devised an added complementary technique (ie, the parachute technique) to the common surgical techniques of the tendon repair to ease the repairing process and improve the outcomes. In this study, 79 patients, from whom 21 patients had 2 injured fingers, with flexor tendon injury in zone II (ie, 100 fingers) underwent this new technique. Finally, the results were hopeful. Thus, this complementary parachute technique combined with an early active mobilization with almost full range of flexion and extension, starting on the first postoperative day, resulted in improved outcomes compared with both passive mobilization and gentle active mobilization with a limited range of motion (ie, "controlled"). The Strickland formula (total active motion) system was used to evaluate the functional results of the flexor tendon repair. Finally, this technique is applicable for tendon repairs, and is shown to produce good results in their hands.

For children between 5-10 years of age with zone II flexor tendon lacerations, the literature recommends a modified early mobilization programme under the supervision of a hand therapist but the fingers are immobilized between physiotherapy sessions. We report on a series of children between 5-10 years of age with flexor tendon lacerations (n = 54 fingers) in zone II repaired with a six-strand core suture (three separate 'figure of eight' sutures) and actively mobilized immediately after surgery similar to adult rehabilitation programmes with no immobilization between the physiotherapy sessions. The average follow-up for the study group was 13 months (range 7-25 months). There were no ruptures. The final outcome was excellent in 46 fingers (85%) and good in the remaining eight fingers (15%) using the Strickland-Glogovac criteria.

A prospective review was carried out to evaluate the outcome of surgically repaired open central slip (zone III) injuries which were treated with 3 weeks of proximal interphalangeal joint immobilization within a cylinder splint and then with 3 weeks of controlled mobilization within a Capener coil splint. Thirty-one fingers in 27 patients were assessed by the same independent therapist. All fingers achieved an excellent or good recovery with a mean proximal interphalangeal joint flexion of 94 degrees (range 70-110 degrees) and a mean distal interphalangeal joint flexion of 57 degrees (range 30-81 degrees). Extension deficits of the proximal interphalangeal joint were noted in five fingers (mean 6 degrees, range 3-15 degrees). The results show that a combination of immobilization and controlled mobilization is an effective rehabilitation regime for surgically repaired open central slip injuries.