This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by SCHEKER, L. R. Articles by O’NEILL, W. L. Search for Related Content PubMed PubMed Citation Articles by SCHEKER, L. R. Articles by O’NEILL, W. L. Social Bookmarking                         What's this?

Functional Results of Dynamic Splinting after Transmetacarpal, Wrist, and Distal Forearm Replantation

From the Christine M. Kleinert Institute for Hand and Micro Surgery, the University of Louisville School of Medicine and Kleinert, Kutz and Associates Hand Care Center, Louisville, Kentucky, USA

Correspondence: Luis R. Scheker, MD, 225 Abraham Flexner Way, Suite 850, Louisville, KY 40202, USA.

The results of replantation at the wrist and distal forearm are reported to be better than at the metacarpal level, in part because the latter involve direct injury to the intrinsic muscles. This study evaluates a new post-operative protocol for replantation at the metacarpal, wrist and distal forearm levels. 3 days after replantation, the patient was placed in a dynamic crane outrigger splint with MP joint control, compensating for intrinsic muscle function loss. From 4 to 12 weeks, an anticlaw splint alternated with the outrigger splint. After 12 weeks, a dynamic wrist extension orthosis was added to the anti-claw splint. 11 patients (four replantations at the transmetacarpal level, three at the wrist and four in the distal forearm) had this protocol between 1988 and 1993. For distal forearm replantation, TAM of fingers averaged 216°, grip strength 42 lb, and pinch strength 7.2 lb with 75% good or excellent results. For wrist replantations, TAM of fingers averaged 243°, grip strength 37 lb and pinch strength 10.6 lb with 100% good or excellent results. For transmetacarpal replantations, TAM of fingers averaged 189°, grip strength 37 lb and pinch strength 5.6 lb, with 75% good and excellent results. Early protected mobilization, as described here, preserves tendon gliding, muscle strength and excursion. Our results support this protocol for wrist and distal forearm replantation and especially for transmetacarpal replantation, the results of which tend to be poor according to the medical literature.

Journal of Hand Surgery (British and European Volume), Vol. 20, No. 5, 584-590 (1995)
DOI: 10.1016/S0266-7681(05)80115-9


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?