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Zon 2 fleksör tendon yaralanmalarında Modifiye Duran Protokolünün klinik sonuçları

Year 2018, Volume: 5 Issue: 3, 150 - 157, 25.12.2018

Abstract

Amaç: Bu çalışmanın amacı zon 2 fleksör tendon yaralanması sonrası primer cerrahi uygulanan bireylerde erken rehabilitasyonun etkinliğinin sonuçlarını değerlendirmekti.

Yöntem: Çalışmaya retrospektif olarak 33 birey (43 parmak) dahil edildi. Dört dikişli merkezi krusiyat dikiş tekniği ile primer tamiri yapılmış bireylerin rehabilitasyonunda, Modifiye Duran Tekniği kullanıldı. Bireylerin fonksiyonellikleri, kol omuz ve el sorunları anketi kısa formu (Q-DASH) ve total aktif hareket formülü (TAH) ile, ağrıları vizüel analog skala (VAS) ile, ödemleri ise sekiz şekilli ölçüm yöntemi ile değerlendirildi.

Bulgular: Rehabilitasyon programı sonrasında, Q-DASH, ödem ve ağrı skorları açısından iyileşme olduğu saptandı (p<0,001). Total Aktif Hareket skorları incelendiğinde 39 parmağın orta, iyi veya mükemmel olarak değerlendirildiği görüldü.

Sonuç: Dört dikişli merkezi krusiyat dikiş tekniği ile tamir edilmiş Zon 2 fleksör tendon yaralanmalı bireylerde Modifiye Duran Protokolü’nün, komplikasyonları azaltan ve fonksiyonelliği artıran bir yöntem olduğu düşünülmektedir.

References

  • 1. Singer M, Maloon S. Flexor tendon injuries: the results of primary repair. J Hand Surg Am. 1988;13:269-272.
  • 2. Haese JB. Psychological aspects of hand injuries: their treatment and rehabilitation. J Hand Surg Am. 1985;10:283-287.
  • 3. Çeliker R, İnanıcı F, Dinçer F. Classification and etiological evaluation of hand problems. Eur J Phys Med Rehabil. 1996;6:38.
  • 4. Dy CJ, Daluiski A. Update on zone II flexor tendon injuries. J Am Acad Orthop Surg. 2014;22:791-799.
  • 5. Bunnell S. Repair of tendons in the fingers and description of two new instruments. Surg Gynecol Obstet. 1918;126:103-110.
  • 6. Newmeyer WL. Sterling Bunnell, MD: the founding father. J Hand Surg Am. 2003;28:161-164.
  • 7. Dy CJ, Hernandez-Soria A, Ma Y, et al. Complications after flexor tendon repair: a systematic review and meta analysis. J Hand Surg Am. 2012;37:543-551.
  • 8. Rudge WBJ, James M. Flexor tendon injuries in the hand: a UK survey of repair techniques and suture materials: are we following the evidence? ISRN Plastic Surgery. 2014;1:1-4. doi:10.1155/2014/687128.
  • 9. Newmeyer WL, Manske PR. No man’s land revisited: the primary flexor tendon repair controversy. J Hand Surg Am. 2004;29:1-5.
  • 10. Gibson PD, Sobol GL, Ahmed IH. Zone II flexor tendon repairs in the United States: trends in current management. J Hand Surg Am. 2017;42:99-108.
  • 11. Tang JB, Gu YT, Rice K, et al. Evaluation of four methods of flexor tendon repair for post operative active mobilization. Plast Reconstr Surg. 2001;107:742–749.
  • 12. Lalonde DH, Martin AL. Wide-awake flexor tendon repair and early tendon mobilization in zones 1 and 2. Hand Clin. 2013;29:207-213.
  • 13. Giesen T, Calcagni M, Elliot D. Primary flexor tendon repair with early active motion. Hand Clin. 2017;33:465-472.
  • 14. Çetin A, Dinçer F, Keçik A, et al. Rehabilitation of flexor tendon injuries by use of a combined regimen of modified Kleinert and modified Duran techniques. Am J Phys Med. 2001;80:721-728.
  • 15. Duran RJ, Coleman CR, Nappi JF. Management of flexor tendon lacerations in zone 2 using controlled motion postoperatively. In: Rehabilitation of the Hand: Surgery and Therapy. Hunter JM, Schneider LH, Mackin EJ, et al. eds. St. Louis, CV Mosby; 1990:410-413.
  • 16. Rosberg HE, Carlsson KS, Höjgard S, et al. What determines the costs of repair and rehabilitation of flexor tendon injuries in zone II? A Multiple regression analysis of data from Southern Sweden. J Hand Surg (Br) 2003;28B:106-12.
  • 17. Duran R, Houser R, Coleman C, et al. A preliminary report in the use of controlled passive motion following flexor tendon repair in zones II and III. J Hand Surg Am.1976;1:79.
  • 18. Düger T, Yakut E, Öksüz Ç, et al. Kol, Omuz, El Sorunları (Disabilities of the Arm, Shoulder and Hand-DASH) Anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Turk J Physiother Rehabil. 2006;17:99-107.
  • 19. Dogan SK, Ay S, Evcik D, et al. Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clin Rheumatol. 2011;30:185-91.
  • 20. Leard JS, Breglio L, Fraga L, et al. Reliability and concurrent validity of the figure-of-eight method of measuring hand size in patients with hand pathology. J Orthop Sports Phys Ther. 2004;34:335-340.
  • 21. Pellecchia GL. Figure-of-eight method of measuring hand size: reliability and concurrent validity. J Hand Ther. 2003;16:300-304.
  • 22. Maihafer GC, Llewellyn MA, Pillar WJ, et al. A comparison of the figure-of-eight method and water volumetry in measurement of hand and wrist size. J Hand Ther. 2003;16:305-310.
  • 23. Starnes T, Saunders RJ, Means KR. Clinical outcomes of zone II flexor tendon repair depending on mechanism of injury. J Hand Surg Am. 2012;37:2532-2540.
  • 24. Strickland JW, Glogovac SV. Digital function following flexor tendon repair in Zone II: a comparison of immobilization and controlled passive motion techniques. J Hand Surg Am. 1980;5:537-543.
  • 25. Moriya K, Yoshizu T, Maki Y, et al. Clinical outcomes of early active mobilization following flexor tendon repair using the six-strand technique: short-and long-term evaluations. J Hand Surg Eur. 2015;40:250-258.
  • 26. Rouhani A, Tabrizi A, Ghavidel E. Effects of non-steroidal anti-inflammatory drugs on flexor tendon rehabilitation after repair. Arch Bone Joint Surg. 2013;1:28-30.
  • 27. Susanna MB, Angela DR, Mauro P. et al. Manual lymph drainage improving upper extremity edema and hand function in patients with systemic sclerosis in edematous phase. Arth Care Res. 2011;63:1134-1141.
  • 28. Apfelbaum JL, Chen C, Mehta SS, et al. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534-540.
  • 29. Rawal N, Allvin R, Amilon A, et al. Postoperative analgesia at home after ambulatory hand surgery: a controlled comparison of tramadol, metamizol, and paracetamol. Anesth Analg. 2001;92:347-351.
  • 30. Vranceanu AM, Jupiter JB, Mudgal CS, et al. Predictors of pain intensity and disability after minor hand surgery. J Hand Surg Am. 2010;35:956-960.
  • 31. Umay E, Gürçay E, Çevikol A, et al. El tendon yaralanmalarının rehabilitasyonunda erken ve geç mobilizasyon sonuçlarının karşılaştırılması. Turk J Phys Med Rehab. 2009;55:147-152.
  • 32. Öz B, Bal S, Demirdöven C, et al. Early rehabilitation outcome and demographic and clinical features of patients with traumatic tendon injury. Turk J Phys Med Rehab. 2009;55:19-24.
  • 33. Kayalı C, Eren A, Ağuş H, et al. Çocuklarda ikinci bölge fleksor tendon yaralanmalarında primer onarım ve erken pasif rehabilitasyon sonuçları. Acta Orthop Traumatol Turc. 2003;37:249-253.
  • 34. Rrecaj S, Martinaj M, Murtezani A, et al. Physical therapy and splinting after flexor tendon repair in zone II. Med Arch. 2014;68:128-131.
  • 35. Elliot D, Moiemen NS, Flemming AFS, et al. The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regimen. J Hand Surg 1983;19B:607-612.
  • 36. Trumble TE, Vedder NB, Seiler JG 3rd et al. Zone-II flexor tendon repair: a randomized prospective trial of active place-and-hold therapy compared with passive motion therapy. J Bone Joint Surg Am. 2010;92:1381-1389.
  • 37. Edsfeldt S, Rempel D, Kursa K, et al. In vivo flexor tendon forces generated during different rehabilitation exercises. J Hand Surg Eur Vol. 2015;40:705-710.

Clinical outcomes of Modified Duran Protocol following zone 2 flexor tendon injuries

Year 2018, Volume: 5 Issue: 3, 150 - 157, 25.12.2018

Abstract

Purpose: The purpose of this study was to evaluate the effectiveness of early rehabilitation in patients undergoing primer surgery following zone-2 flexor tendon injury.

Methods: Thirty three cases (43 fingers) were included in this study, retrospectively. Modified Duran Protocol was applied to the individuals who undergone primer repair with 4-strand cruciate core technique. Functionality, pain and edema of the cases were assessed with Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) and total active motion (TAM), visual analogue scale (VAS), and with figure-of eight method, respectively.

Results: There were significant improvements in Q-DASH, edema and pain scores were recorded (p<0.001). Thirty-nine fingers were evaluated as fair, good or excellent according to TAM scores.

Conclusion: We suggest that Modified Duran Protocol reduces complications and improves function in Zone 2 flexor tendon injured cases that are repaired with four strand cruciate core technique.

References

  • 1. Singer M, Maloon S. Flexor tendon injuries: the results of primary repair. J Hand Surg Am. 1988;13:269-272.
  • 2. Haese JB. Psychological aspects of hand injuries: their treatment and rehabilitation. J Hand Surg Am. 1985;10:283-287.
  • 3. Çeliker R, İnanıcı F, Dinçer F. Classification and etiological evaluation of hand problems. Eur J Phys Med Rehabil. 1996;6:38.
  • 4. Dy CJ, Daluiski A. Update on zone II flexor tendon injuries. J Am Acad Orthop Surg. 2014;22:791-799.
  • 5. Bunnell S. Repair of tendons in the fingers and description of two new instruments. Surg Gynecol Obstet. 1918;126:103-110.
  • 6. Newmeyer WL. Sterling Bunnell, MD: the founding father. J Hand Surg Am. 2003;28:161-164.
  • 7. Dy CJ, Hernandez-Soria A, Ma Y, et al. Complications after flexor tendon repair: a systematic review and meta analysis. J Hand Surg Am. 2012;37:543-551.
  • 8. Rudge WBJ, James M. Flexor tendon injuries in the hand: a UK survey of repair techniques and suture materials: are we following the evidence? ISRN Plastic Surgery. 2014;1:1-4. doi:10.1155/2014/687128.
  • 9. Newmeyer WL, Manske PR. No man’s land revisited: the primary flexor tendon repair controversy. J Hand Surg Am. 2004;29:1-5.
  • 10. Gibson PD, Sobol GL, Ahmed IH. Zone II flexor tendon repairs in the United States: trends in current management. J Hand Surg Am. 2017;42:99-108.
  • 11. Tang JB, Gu YT, Rice K, et al. Evaluation of four methods of flexor tendon repair for post operative active mobilization. Plast Reconstr Surg. 2001;107:742–749.
  • 12. Lalonde DH, Martin AL. Wide-awake flexor tendon repair and early tendon mobilization in zones 1 and 2. Hand Clin. 2013;29:207-213.
  • 13. Giesen T, Calcagni M, Elliot D. Primary flexor tendon repair with early active motion. Hand Clin. 2017;33:465-472.
  • 14. Çetin A, Dinçer F, Keçik A, et al. Rehabilitation of flexor tendon injuries by use of a combined regimen of modified Kleinert and modified Duran techniques. Am J Phys Med. 2001;80:721-728.
  • 15. Duran RJ, Coleman CR, Nappi JF. Management of flexor tendon lacerations in zone 2 using controlled motion postoperatively. In: Rehabilitation of the Hand: Surgery and Therapy. Hunter JM, Schneider LH, Mackin EJ, et al. eds. St. Louis, CV Mosby; 1990:410-413.
  • 16. Rosberg HE, Carlsson KS, Höjgard S, et al. What determines the costs of repair and rehabilitation of flexor tendon injuries in zone II? A Multiple regression analysis of data from Southern Sweden. J Hand Surg (Br) 2003;28B:106-12.
  • 17. Duran R, Houser R, Coleman C, et al. A preliminary report in the use of controlled passive motion following flexor tendon repair in zones II and III. J Hand Surg Am.1976;1:79.
  • 18. Düger T, Yakut E, Öksüz Ç, et al. Kol, Omuz, El Sorunları (Disabilities of the Arm, Shoulder and Hand-DASH) Anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Turk J Physiother Rehabil. 2006;17:99-107.
  • 19. Dogan SK, Ay S, Evcik D, et al. Adaptation of Turkish version of the questionnaire Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) in patients with carpal tunnel syndrome. Clin Rheumatol. 2011;30:185-91.
  • 20. Leard JS, Breglio L, Fraga L, et al. Reliability and concurrent validity of the figure-of-eight method of measuring hand size in patients with hand pathology. J Orthop Sports Phys Ther. 2004;34:335-340.
  • 21. Pellecchia GL. Figure-of-eight method of measuring hand size: reliability and concurrent validity. J Hand Ther. 2003;16:300-304.
  • 22. Maihafer GC, Llewellyn MA, Pillar WJ, et al. A comparison of the figure-of-eight method and water volumetry in measurement of hand and wrist size. J Hand Ther. 2003;16:305-310.
  • 23. Starnes T, Saunders RJ, Means KR. Clinical outcomes of zone II flexor tendon repair depending on mechanism of injury. J Hand Surg Am. 2012;37:2532-2540.
  • 24. Strickland JW, Glogovac SV. Digital function following flexor tendon repair in Zone II: a comparison of immobilization and controlled passive motion techniques. J Hand Surg Am. 1980;5:537-543.
  • 25. Moriya K, Yoshizu T, Maki Y, et al. Clinical outcomes of early active mobilization following flexor tendon repair using the six-strand technique: short-and long-term evaluations. J Hand Surg Eur. 2015;40:250-258.
  • 26. Rouhani A, Tabrizi A, Ghavidel E. Effects of non-steroidal anti-inflammatory drugs on flexor tendon rehabilitation after repair. Arch Bone Joint Surg. 2013;1:28-30.
  • 27. Susanna MB, Angela DR, Mauro P. et al. Manual lymph drainage improving upper extremity edema and hand function in patients with systemic sclerosis in edematous phase. Arth Care Res. 2011;63:1134-1141.
  • 28. Apfelbaum JL, Chen C, Mehta SS, et al. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97:534-540.
  • 29. Rawal N, Allvin R, Amilon A, et al. Postoperative analgesia at home after ambulatory hand surgery: a controlled comparison of tramadol, metamizol, and paracetamol. Anesth Analg. 2001;92:347-351.
  • 30. Vranceanu AM, Jupiter JB, Mudgal CS, et al. Predictors of pain intensity and disability after minor hand surgery. J Hand Surg Am. 2010;35:956-960.
  • 31. Umay E, Gürçay E, Çevikol A, et al. El tendon yaralanmalarının rehabilitasyonunda erken ve geç mobilizasyon sonuçlarının karşılaştırılması. Turk J Phys Med Rehab. 2009;55:147-152.
  • 32. Öz B, Bal S, Demirdöven C, et al. Early rehabilitation outcome and demographic and clinical features of patients with traumatic tendon injury. Turk J Phys Med Rehab. 2009;55:19-24.
  • 33. Kayalı C, Eren A, Ağuş H, et al. Çocuklarda ikinci bölge fleksor tendon yaralanmalarında primer onarım ve erken pasif rehabilitasyon sonuçları. Acta Orthop Traumatol Turc. 2003;37:249-253.
  • 34. Rrecaj S, Martinaj M, Murtezani A, et al. Physical therapy and splinting after flexor tendon repair in zone II. Med Arch. 2014;68:128-131.
  • 35. Elliot D, Moiemen NS, Flemming AFS, et al. The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regimen. J Hand Surg 1983;19B:607-612.
  • 36. Trumble TE, Vedder NB, Seiler JG 3rd et al. Zone-II flexor tendon repair: a randomized prospective trial of active place-and-hold therapy compared with passive motion therapy. J Bone Joint Surg Am. 2010;92:1381-1389.
  • 37. Edsfeldt S, Rempel D, Kursa K, et al. In vivo flexor tendon forces generated during different rehabilitation exercises. J Hand Surg Eur Vol. 2015;40:705-710.
There are 37 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Öznur Büyükturan

İsmail Ceylan This is me

Zafer Erden This is me

Ömer Erçetin This is me

Publication Date December 25, 2018
Submission Date January 7, 2018
Published in Issue Year 2018 Volume: 5 Issue: 3

Cite

Vancouver Büyükturan Ö, Ceylan İ, Erden Z, Erçetin Ö. Zon 2 fleksör tendon yaralanmalarında Modifiye Duran Protokolünün klinik sonuçları. JETR. 2018;5(3):150-7.