Zone 2 flexor tendon injuries: Our experience with early active movement protocol for rehabilitation of tendons

Introduction: Flexor tendon injuries of the hand are common occurring these days and its management is still far from ideal. The functional outcome of zone 2 flexor tendon injuries are not good in view of higher incidence of adhesion formation. Numerous studies have been reported but yet nothing is deemed ideal. Objective: This study was conducted to see the results of primary repair of zone 2 flexor tendon injuries with prolene suture and early supervised aggressive mobilization and rehabilitation protocol. Design: Prospective study (Level IV evidence) reporting case series. Setting: Academic hospital associated with a medical college Participants: All patients with isolated flexor tendon injuries in zone 2 of the hand. Interventions: All tendons were repaired with prolene suture using standard operative procedures. Immediate splintage was done with thermoplastic splints and hand kept in dorsal blocking of 20 degrees flexion at wrist and 75 degrees at metacarpophalangeal joint. Rubber elastic springs were used for passive flexion which were fixed at nails and distal forearm. Early postoperative exercises were started after 48 hours of repair under direct supervision with passive extension and flexion. Gradually active exercises were added to the protocol. Finger splint was used for 4 weeks during whole day and after that it was used during night time only. Outcome measures: Outcome (tendon excursion) was evaluated using Strickland evaluation system and categorized as excellent, good, fair and poor. Results: A total of 50 patients (males- 32; females- 18) with zone 2 flexor tendon injuries were included and analyzed. Overall 85.7% digits had excellent or good results. Patients with single digit involvement had 94% excellent result in comparison to 31% in multiple digit involvement group (p