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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Shorter Rehabilitation after Extensor Pollicis Longus Reconstruction Combining Modern Suture Technique and New Rehabilitation Protocol

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  • presenting/speaker Tim Cordier - Kantonsspital Graubünden, Chur, Switzerland
  • Silvia Schibli - Kantonsspital Graubünden, Chur, Switzerland

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-362

doi: 10.3205/19ifssh0918, urn:nbn:de:0183-19ifssh09185

Published: February 6, 2020

© 2020 Cordier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Reconstruction of Extensor pollicis longus (EPL) function is realized by transferring the tendon of the Extensor indicis (EI) to the distal part of the EPL. Common suture techniques combined with established rehabilitation protocols have proven to achieve good results. However, patients regularly experience an impairment of the operated hand for three months. In addition established rehabilitation protocols tend to be complex and depending on substantial support from hand therapists.

Compared to common suture methodes newer Side-to-Side (STS) suture techniques provide improved strength and have been successfully implemented for tendon transfers.

Hypothesis of this prospective study is that the combination of a Side-to-Side suture technique with a straightforward active rehabilitation protocol based on the increased suture stability simplifies and shortens time of rehabilitation after EPL reconstruction.

Methods: Between 11/2015 and 04/2017 we treated a series of 10 patients, median age 56 (range 18-70) after spontaneous EPL-rupture using STS suture technique for EI to EPL transfer. For postoperative rehabilitation we implemented a simplified Controlled-Active-Motion protocol. Clinical follow up was at 2, 4 and 8 weeks postoperatively and additionally one year later by phone. Primary endpoints were the unrestricted use of the operated hand and major complications, defined as tendon rupture or relevant tendon elongation. We reported on patient satisfaction and pain. As objective parameter active range of motion of the thumb and index finger as well as pinch and grip strength were measured.

Results and Conclusions: All 10 patients underwent surgery and postoperative rehabilitation without complication. All patients were satisfied with the treatment 8 weeks and one year postoperatively. All were back to work after 8 weeks or could use the operated hand without any restriction. At 8 weeks all patients achieved a powerful active extension of the IP-joint of the thumb. Pinch- and grip- strength reached on average 83% and 81% of the contralateral side. There was no lost to follow up.

Despite the small patient group and the relative short follow up the results suggest that the Side-to-side suture technique in combination with an adapted active rehabilitation protocol provides a safe and successful method for EPL- reconstruction. Compared with the current literature this concept shortens time of rehabilitation by a third.