title: Early free active versus dynamic extension splinting after extensor indicis proprius tendon transfer to restore thumb extension: a prospective randomized study.
abstract: OBJECTIVE
  Transfer of the extensor indicis proprius tendon to the distal extensor pollicis longus (EPL) tendon is a standard operation to restore thumb extension. However, several postoperative hand therapy regimens exist. The previously described early dynamic extension splinting protocol has become our standard, and we now compare it with an early active protocol in a prospective randomized study.
  
  
  METHODS
  Twenty-one patients with a closed EPL tendon rupture in zones T4 and T5 were treated with an extensor indicis proprius tendon transfer and were randomly divided into 2 postoperative physical therapy regimens: one group (DY) was treated with a dynamic protocol using a rubber-band system, and the other group (AC) was allowed an early active thumb extension with limited flexion. All patients were evaluated for active range of motion (ROM) of the thumb and for grip and tip-pinch strength 3, 4, 6, and 8 weeks postoperatively. Long-term outcomes were not evaluated.
  
  
  RESULTS
  Three weeks postoperatively, DY group patients demonstrated a significantly better active ROM in the interphalangeal joint than that of the AC group patients. DY group patients achieved 72% of contralateral joint active ROM compared with 49% of contralateral joint active ROM achieved in the AC group. However, no significant difference was found during further course of study resulting in a final mean interphalangeal joint active ROM of 69 degrees (range, 45 degrees to 110 degrees) in group DY and of 58 degrees (range, 40 degrees to 75 degrees) in group AC. The mean grip strength and tip-pinch strength did not differ significantly after 8 weeks with patients achieving 66% and 73%, respectively, of the contralateral side in group DY and 63% and 71%, respectively, of the contralateral side in group AC. Three complications--one due to rupture (DY group), one due to adhesion, and one due to inadequate joint motion secondary to poor tendon tensioning at the time of initial surgery (both AC group)--occurred during a 1-year follow-up.
  
  
  CONCLUSIONS
  Considering the small group sizes, both regimens (dynamic vs early active) achieved comparable clinical results. The early active protocol does not have a notably higher complication rate but fails to accelerate rehabilitation.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Department for Hand, Plastic and Reconstructive Surgery, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Ludwigshafen am Rhein, Germany. giesslerplasticsurgery@hotmail.com
authors.forename: Goetz A
authors.initials: GA
authors.lastname: Giessler
authors.forename: Mirko
authors.initials: M
authors.lastname: Przybilski
authors.forename: Guenter
authors.initials: G
authors.lastname: Germann
authors.forename: Michael
authors.initials: M
authors.lastname: Sauerbier
authors.forename: Kai
authors.initials: K
authors.lastname: Megerle
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011183:Postoperative Complications; D011446:Prospective Studies; D016059:Range of Motion, Articular; D013165:Splints; D013708:Tendon Injuries / Q000534:rehabilitation / Q000601:surgery*; D013709:Tendon Transfer / Q000379:methods*; D013933:Thumb / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome