Article
The Clinical Outcome of The Novel Hand Therapy Protocol That Based on Staged Outcome Assessment for Zone 1 and 2 Flexor Tendon Injuries – A Preliminary Study
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Authors
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Hideyuki Ota
- Department of Orthopaedic Surgery, Nagoya Ekisaikai Hospital, Nagoy, Japan
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Yoshiyuki Inagaki
- Department of Rehabilitation, Nagoya Ekisaikai Hospital, Nagoya, Japan
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Kentaro Watanabe
- Department of Orthopaedic Surgery, Nagoya Ekisaikai Hospital, Nagoy, Japan
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: We treated by modified Kleinert regimens (mKR) combined with 4 or 6 strands core suture for flexor tendon injuries in Zones 1 and 2 to 2015. Watanabe reported the novel core suture technique that named 8-strand core suture cross-locked cruciate procedure (Watanabe procedure: WP) in 2016. The purpose of developing WP is for establishing the standardized EAM protocol that is not depend on experience of hand therapist. We assessed the cases who treated by mKR and compared the outcome between excellent, good outcome cases and fair, poor cases. Thus, we calculated the cutoff value to set target value up. After that, we invent the novel EAM protocol that based on the target value. The purpose of this study, one is to point the evidence of novel EAM protocol out, another is to indicate the clinical outcome of the patients who treated by the novel EAM protocol.
Methods: We reviewed the outcome of the patients who treated by mKR (34 patients 40 fingers) in our institution between 2008 and 2015. We assessed the ROM of the PIP, the DIP joints, and the outcome of original Strickland's criteria. We define them as A group (35 patients 29 fingers) were Excellent and Good in the outcome of original Strickland's criteria, and B group (5 patients 5 fingers) were Fair and Poor in the outcome of original Strickland's criteria. Thus, we calculated the cutoff value by receiver operating characteristic curve (ROC) after the operation 4, 6, 8 weeks. And we reviewed the the clinical outcome of the novel EAM protocol combined with WP (EAMWP) of 7 fingers 7 patients between 2016 and 2017. We assessed the ROM, the outcome of original Strickland's criteria at final visit.
Results and Conclusions: The mean ROMs in group A and B at 2, 4, 6, 8 weeks are shown in Table 1. Thus, the cutoff value at 4, 6, 8 weeks from the ROC are shown Table 2.
We set the target value up, PIP flexion 75°/80°/90°/100°, PIP extension -30°/-20°/-10°/0 °, DIP flexion 40°/40°/50°/60°, DIP extension -10°/-5°/0°/0°at 2, 4, 6, 8 weeks respectively. We established the target value of EAMWP at 2 weeks that based on the result. The original Strickland's criteria of all patients who treated treated with EAMWP was excellent. The mean ROMs are PIP flexion 100±4°, PIP extension -3±7°, DIP flexion 71±10°, DIP extension -3±4° at final visit. There was no complication in 7cases.
