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A 50-year-old patient, who is a window installer, sustained a work-related injury to his right dominant hand resulting in a laceration of his index and middle finger tendons. Post-surgery, he has been referred to the hand clinic by the orthopedic surgeon for a flexor tendon dynamic splint. The hand therapist is advised to follow the Modified Kleinert protocol, which uses traction to apply a force to hold the fingers in flexion but allows full active extension of the IP joints against the force of the traction. i.e. Passive flexion and active extension within the limits of splint. What is the recommended position of the wrist and hand for fabricating this splint on this patient?
=> Wrist in neutral with MCPs in 50-70 degrees flexion and IPs fully extended
=> Wrist in 15 degrees extension, MCPs in 30 degrees flexion and IPs fully flexed
=> Wrist in 30-45 degrees extension, MCPs in 10 degrees flexion and IPs fully flexed
=> Wrist in 30-40 degrees flexion, MCPs in 50-70 degrees flexion, and IPs fully extended

D. Wrist in 30-40 degrees flexion, MCPs in 50-70 degrees flexion, and IPs fully extended. This position prevents flexion contractures of the PIP and DIP when full extension is allowed, while preventing re-injury of the tendon repair when the wrist is flexed. It will also increase tensile strength of the repaired tendon and limits scar formation that could lead to limited tendon excursion. The original Kleinert protocol is no longer used in the original form The modified Kleinert protocol also referred to as the Kleinert & Chow protocol, is a controlled active extension and passive flexion motion protocol. The wrist is palmary flexed with a dorsal protective splint with 30–40° wrist flexion, 50– 70° MCP joint flexion, and the IP joints are allowed full extension. https://www.slideshare.net/MohammedAljodah/hand-rehabilitation-after-flexor-tendon-repair-55186598 Coppard, Brenda M.Lohman, Helene. (2008) Introduction to Splinting: A clinical reasoning and problem-solving approach (2nd Edition). St. Louis : Mosby, pp 265-267

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Asked on August 28, 2019 1:28 pm
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