Efficacy Analysis of the Silfverskiold Repair for Extensor Tendon Injury in Zones Ⅴ-Ⅶ Followed by Early Active Motion Rehabilitation and Postoperative Psychological Care

Abstract

The skin on the back of the hand is thin, and extensor tendon injury in zones Ⅴ-Ⅶ is common. The traditional treatment scheme is injured limb braking for 4-6weeks after zigzag cross seam, after that rehabilitation exercise was taken, which would lead to tendon adhesion and long rehabilitation cycle. The long-term functional recovery of patients caused most patients with hand trauma have serious psychological pressure. It is necessary to explore a new treatment method to improve the long-term function of this kind of patients. It was reviewed that the Silfverskiold repair for extensor tendon injuries in zones Ⅴ-Ⅶ, followed by early active motion rehabilitation and postoperative psychological care, and good results were achieved. This paper evaluated the effect of the early active motion rehabilitation and postoperative psychological care after the Silfverskiold repair for extensor tendon injuries. To evaluate the curative effect analysis of the Silfverskiold repair for extensor tendon injuries in zones Ⅴ-Ⅶ, followed by early active motion rehabilitation and postoperative psychological care. Between March 2015 and October 2018, a total of 43 patients with 84 digital extensor tendon lacerations in zones Ⅴ-Ⅶ were included in this study. The tendon repairs used Silfverskiöld technique involving a standard modified Kessler core suture and a running cross-stitch epitendinous suture. Within seven days postoperatively, the patient began wearing a splint with the wrist in 20 degrees extension .The splint allowed patient to actively flex and extend the fingers, but blocked the MP joints from 40 degrees flexion. Exercise were carried out ten times per hour. At night, another splint was added to the main splint and positioned the MCP joints and IP joints in extension. After four weeks, the splint was discontinued, and the patients began active digital motion. Protective static splinting was continued with the interphalangeal joints in full extension during the night and outdoors for another 2 weeks. Miller’s system was applied to evaluate the function postoperatively. The follow-up period ranged from 2 to 6 months, with an average of 4 months.29 of the 43 patients regained full range of motion within 8 weeks postoperatively. At the final follow- up, according to Miller’s criteria, the results were graded as ‘excellent’ and ‘good’ in 96% of the digits, and as ‘fair’ in the remainder. There was no rupture of the repaired tendon. Early postoperative active activity has been widely used in the postoperative treatment of flexor tendon injury, but there were few reports about the application after extensor tendon repair. Previous studies had shown that early active activity can promote the regression of wound swelling and reduce tendon adhesion. The stress generated by activity is conducive to the longitudinal arrangement of new tendon fibers, avoid tendon softening and increase the strength of tendon healing. At the same time, the early active activity scheme is relatively simple and easy to be under stood and accepted by patients, but firm tendon suture is the prerequisite to prevent tendon rupture in the process of early rehabilitation. The Silfverskiold repair for extensor tendon injuries in zones Ⅴ-Ⅶ, followed by early active motion rehabilitation yields excellent results, and is quite safe without increasing the risk of tendon rupture.