Rapid Review: Is Finger Splinting Necessary after Flexor Tendon Repair?

Outcome of Flexor Tendon Repair Using Eight-Strand Core Stitch Without Postoperative Finger Splinting

Reference: El-Gammal, T. A., Kotb, M. M., Ragheb, Y. F., El-Gammal, Y. T., & Anwar, M. M. (2024). Outcome of Flexor Tendon Repair Using Eight-Strand Core Stitch Without Postoperative Finger Splinting. HAND. https://doi.org/10.1177/15589447231220686

The Skinny:

The purpose of this study was to evaluate the clinical outcomes of using an 8-strand double-cruciate core suture technique for flexor tendon repair, followed by early active motion without finger splinting and with the wrist held in a neutral position. 

In the Weeds:

This prospective cohort study design involved 35 patients with 41 affected digits who sustained complete laceration of the flexor digitorum profundus (FDP) or flexor pollicis longus (FPL) tendon in zones II and III. All patients underwent a repair using an 8-strand double-cruciate core suture with four cross-grasping stitches under wide-awake local anesthesia without a tourniquet (WALANT). A running epitenon suture reinforced the repair, the FDS tendon was partially removed, and the A2 and A4 pulleys were vented as needed to improve tendon gliding. Postoperatively, on day one patients began passive motion and on day three began active motion without finger splinting. Only a neutral wrist was used for splinting. Light grasping was allowed at four weeks, and power grasping began at ten weeks. Outcomes were assessed for six months using the Strickland-Glocovac, Buck-Gramcko, and DASH measures. 

Bringing it Home:

The average total active motion (TAM) was 151° ± 22° (86% ± 13%). Based on the Strickland-Glocovac criteria, a combined 86.2% of finger repairs achieved excellent or good outcomes, while the Buck-Gramcko scale sowed a combined of 83.4% excellent or good results for thumb repairs. Mean thumb IP motion was 68° ± 23°, with extension lags of 21° ± 11° for fingers and 12° ± 4° for thumbs. The mean DASH score was 4.75, indicating excellent functional recovery with minimal disability. Four thumbs underwent complications in the study including bowstringing, flexion contracture, and/or ruptures.  

Rating: 

4/5 – This study effectively explores the outcomes of an 8-strand tendon repair with early active motion and no finger splinting in a well-designed manner. However, the small sample size, lack of control group, and potential bias from the surgeon-directed rehabilitation limits the strength of the study. This study highlights how the 8-strand tendon repair can allow for early active mobilization without the need for complex splinting or continuous therapist supervision.