The Saint John Protocol Dr. Michael Thomas Edgerton *Deviations from protocol will be noted on script. The combined Kleinert and Duran protocols and the early active motion protocols exhibited the highest proportion of digits with excellent or. analysed differences in range of motion between the various rehabilitation protocols. Dans le courant actif, il existe deux principaux protocoles. Frula dinmica Tcnica de Kleinert. Orthoses for Tendon Management | Musculoskeletal Key Etiology - Unknown. Orthotic Intervention for the Hand and Upper Extremity: Splinting Principles and Process. 2 basic types of protocols - Kleinert - Rubber band traction within DBS - Duran and Houser- Passive exercise with DBS Forearm based Dorsal blocking splint (DBS) applied at surgery - Wrist and MP joints blocked in flexion • Places tendons on slack - IP joints are left free • And may extend to neutral within the splint Diagnosis is made clinically by observing the resting posture of the hand to assess the digital cascade and the absence of the tenodesis effect. Rééducation des tendons des fléchisseurs des doigts ... 0-4 weeks (early phase): DORSAL BLOCK SPLINT -Wrist positioned in 20-30 degrees flexion -MCP its in 50-60 degrees flexion -IP joints extended -Passive flexion & active extension w/i limits of splint 4-7 weeks (intermediate phase): Continue DORSAL BLOCK SPLINT, but adjust wrist to neutral -Place/hold exercises and differential . Rehabilitation of flexor tendon injuries by use of a ... logs of orthopaedic operating rooms and emergency . Introduction. The Klei-nert protocol originally had a splint made of cast materialandrubber bandtraction passively flexing the proximal interphalangeal (PIP) joints only.2 The wrist was positioned in 45 of flexion and 10 to At a duran flexor tendon protocol you can comfortably grip strength of locking and duran protocol flexor tendon repair protocol. Physiotherapists and occupational therapists are often involved and play a key role in the post-surgical rehabilitation of flexor tendon repairs. Tap card to see definition . Diagnosis is made clinically by observing the resting posture of the hand to assess the digital cascade and the absence of the tenodesis effect. 1 To achieve better gliding function of the digital tendons by reducing peritendinous adhesions without . PRINCIPLES OF TENDON REPAIR - TeachMe Orthopedics Patients should be observed at least twice weekly by the surgeon and more frequently by the therapist. September Report on Hands from Doctors Demystify Flexor tendon injuries are some of the more common injuries, but yet complex injuries managed by hand surgeons. Patients treated with place and active hold exercises had significantly greater total active motion eight weeks after surgery than patients treated with controlled passive mobilization (114) (modified Klinert). Kleinert protocol. Compare Search ( Please select at least 2 keywords ) Most Searched Keywords. For comparison, early stage protocols were divided into immobilization, passive motion (including both Kleinert and Duran type protocols), active motion, and continuous motion. Our four conveniently located offices combine both orthopedic care and specialized physical therapy. Kleinert (active extension, rubber-band passive flexion) and Duran (passive extension, passive flexion) protocols are two basic types of early motion programs for rehabilitation of flexor tendon. The original Kleinert and Duran protocols were modified over the years by hand therapists. Healthy restaurants mn 2 . (18) in their study reported the result of patients with flexor tendon injury in zone II, who after intervention were rehabilitated with early passive mobi- Convenient Southwest Virginia orthopedics. AIM: The aim of this study was to evaluate rehabilitation results after surgery repair of flexor tendon injuries in the hand with the early passive mobilization--Kleinert protocol. ed by Washington regime (Kleinert protocol combination with Duran Protocol) and they achieved this results: 36% were excellent, 12% good, 20% fair and 32% poor (10). The Nieduski and Powell study found that: Tendon repair strength of at least four strands is necessary to withstand the force of true active motion. Duran protocol. 2- Immediate passive extension protocol Used for complex injury1 Splint Extension outrigger that support your wrist in . En la tcnica actual se utiliza un tipo de frula especfica que flexiona los dedos directamente hacia la palma de la mano (Figura 4). One hundred three patients (119 fingers) at 8 centers were randomized into an EAF or PF (combined Kleinert and Duran) protocol. o Assess passive motion - if passive motion is limited, continue passive motion as well. Kleinert (active extension-passive flexion), now often amalgamated with that of Duran-Houser, . All children had immediate postoperative mobilization according to the protocol that pro-vides specific guidelines for . No statistically significant differences were found. There is no statistical difference between two-Strand( Modified Kessler) and four-strand(McLarney) techniques of flexor tendon repair following a Kleinert Passive Motion Protocol in terms of rupture, total active motion, grip strength and adhesion on in vivo testing. CRPS used to be known as reflex sympathetic dystrophy (RSD) and causalgia. The protocol was also assists in. sta utiliza un sistema de barra que reduce la resistencia, disminuyendo as el riesgo de contracturas. Additionally, Chesney et al. In the case presented, our patient was found to have complete transection of the Flexor Digitorum Superficialis (FDS) and Flexor . He reported 92 % "excellent" and "good" results in the Buck-Gramcko Score, for the Kleinert protocol, 86 % for the Duran protocol and 95 % for the combined Kleinert and Duran. Kleinert Protocol :- Duran and Kleinert use dynamic traction to rest the digit in flexion, but the Kleinert and colleagues uses the rubber band to resist full active extension. Physical Therapy Zones 2-5 Flexor tendon repair Protocol TimelineSplint Therapeutic Exercise PrecautionsOther Week 3 May initiate serial static PIP extension splints at night if needed. One study included a quality-of-life assessment-meaningful comparison was not possible. Duran Protocol. Function restoration of the fingers after flexor tendon injuries in zone II continues to be a significant challenge in hand surgery (1, 2, 3).The advances to understand the anatomy of the tendons, nutrition, recovery and postoperative rehabilitation has . Doornberg JN, Ring D, Jupiter JB. Gravity. 8. Duran technique. Hand Therapy Home page. Passive flexion and . Modified Duran protocols were compared according to Buck Gramcko score, there was no significant difference between the two protocols (p>0.05). Day 3-5 Post Op - 2 Weeks (Evaluation 3-5 days post op) - "You can move it but you can't use it!" - Edema control -- elevation, compression wrap - Immobilization: DBS - wrist in 45 extension (comfortable position), MCP in 30 degrees of Flexor Tendon Injuries are traumatic injuries to the flexor digitorum superficialis and flexor digitorum profundus tendons that can be caused by laceration or trauma. INTRODUCTION: Rehabilitation after surgery repair of flexor tendon injuries of the hand remains challenging and requires experienced professionals and interdisciplinary approaches. adapted rehabilitation protocol for flexor tendon repairs of children and to evaluate a patient se-ries accordingly. The combined Kleinert and Duran protocols and the early active motion protocols exhibited the highest proportion of digits with excellent or good results using the Strickland and Buck-Gramcko systems. There were 38 patients with 42 injured digits in the Kleinert group, and 34 patients with 39 injured digits in the CAM group. V. Post operative protocol Forearm based dorsal splint made for protection Early active range of motion demonstrated to be superior in terms of post operative range of motion than Kleinert or Duran protocols but has higher risk of rupture The Kleinert protocol is less used nowadays. 1. The majority of the therapists from the rural district indicated that they do not have flexor tendon protocols/ We have reason to believe that the new shorter splint may be superior in terms of . 1. The Nieduski and Powell study found that: Tendon repair strength of at least four strands is necessary to withstand the force of true active motion. Flexor tendon injury rehabilitation - Kleinert protocol Duran protocol: Requires strict patient compliance because other hand is used to perform passive digital flexion exercises. Kleinert Protocol. Here are some of the statistically significant results for average total active motion (PIP + DIP) at 52 weeks. CRPS has acute (recent, short-term) and chronic (lasting greater than six months) forms. If a flexion contracture develops, two options exist: initiation of the Kleinert technique or controlled passive extension of IP joints (with the more proximal joints in the protected position of full flexion). Orthosis: a short dorsal-based orthosis that allows maximal wrist flexion and up to 45 degrees of wrist extension with a block to MP joint extension at 30 degrees. flexor and extensor tendons is confirmed by review of the operative. We offer extended walk-in hours so we are available when you need us. The Kleinert protocol incorporates passive flexion and active extension with the use of rubber bands attached to the patient's fingers.3The modified Duran protocol involves full passive flexion and active extension of the fingers within the constraints of a dorsal block splint (DBS).3There are other protocols as well. by MaryLynn Jacobs and Noelle M. Austin MS PT CHT | Apr 28, 2021. 2006 Jul;20(6):400-4. Flexor Tendon Repairs Therapy. For comparison, early stage protocols were divided into immobilization, passive motion (including both Kleinert and Duran type protocols), active motion, and continuous motion. Place hold for isolated FDS glide of involved digits. Complex regional pain syndrome (CRPS) is a broad term describing excess and prolonged pain and inflammation that follows an injury to an arm or leg. The Kleinert and Duran-Houser protocols are 2 common approaches to postoperative flexor tendon repair therapy consisting of active extension-passive flexion and only passive finger flexion methods, respectively. Two well-known early passive mobilisation protocols are the Duran and Houser and the Kleinert protocols . Flexor tendon injuries in zone II are very frequent because of the anatomical position and submit many clinical problems. Duran Protocol - Thumb. There was no statistically significant difference in TAM achieved between the Kleinert and CAM regimens overall (70% versus 72% of normal in each group respectively, P = 0.70 t-test).Patients over 30 years old achieved significantly worse outcomes in the Kleinert group . Symptoms - Facia becomes thick and contracted, develops cords and bands that extend into the digits. The Manchester short splint permits maximal wrist flexion and up to 45° of wrist extension with a block to 30° of MCP joint extension. The modified Kleinert protocol was used to treat the patients with FTI. B. The adhesions are part of the healing process and almost inevitably produce functional disability following the biological response of the tendon to injury. 3 weeks post-op: o Begin place and hold exercises for digit flexion. Results of 4-strand modified Kessler core suture and epitendinous interlocking suture followed by modified Kleinert protocol for flexor tendon repairs in Zone 2. 1. We designed a Prospective Randomized Controlled Trial of controlled passive mobilization . Fabricate and fit the involved hand in a dorsal block splint positioned at: Complications!Tendon adhesions - most common!Re-rupture - rate 15-25% The Manchester Protocol is appropriate for patients following surgical repair of flexor tendon lacerations in Zone 2, treated with a 4 strand surgical repair. Galanakis et al. In the early stage (0-3 weeks), a modified Kleinert splint was used and passive flexion and active extension exercises were performed 10 times by the patients every hour at home. (allow wound to breathe). In the combined Kleinert and Duran pro- tion protocols. Complications • • • • • Joint contracture Adhesions Rupture Bowstringing Infection 43. !Early passive motion protocols • Duran - low force, low excursion • Kleinert - low force, low excursion • Mayo synergistic - low force, high excursion!Immobilization - children, noncompliant pts. Duran protocol vs kleinert. Kleinert Protocol 40. Primary Upper Extremity and Hand Extensor Tendon Repair Protocol This protocol is not intended to be a substitute for one's clinical decision making regarding the progression of a patient's post-operative course based on their physical exam/findings, individual progress, and/or the presence of post-operative complications. reveal statistical difference between 4-strand, 2-strand or 6-strand repair. Flexor Tendon Injuries are traumatic injuries to the flexor digitorum superficialis and flexor digitorum profundus tendons that can be caused by laceration or trauma. Place/hold for hook, full and straight fist with wrist extended. Early Dynamic Mobilization - Louisville Protocol. The best known early passive mobilisation protocols are the Duran and Houser and Kleinert regimens [73, 74]. He reported 92 % "excellent" and "good" results in the Buck-Gramcko Score, for the Kleinert protocol, 86 % for the Duran protocol and 95 % for the combined Kleinert and Duran. In the Duran and Houser protocol, the postoperative dorsal blocking splint holds the MP joints at 50° of flexion and the wrist at 20° of flexion. Cochrane review (2004) showed good results and trend toward EAM protocols vs immobilisation. 02 $109.99 $109.99. •Kleinert -Dorsal blocking splint -Rubber bands to maintain flexion -Active Extension -Passive Flexion •Modification of Kleinert -Palmar bar to redirect forces and allow greater DIP flexion Rehabilitation •Duran and Houser -Patient controlled passive flexion -Requires greater patient compliance Rehabilitation Remove post-op bulking dressings, inspect the wound and replace with a light dressing. The inclusion criteria were as follows: (1) studies were RCTs or comparative studies; (2) the rehabilitation protocols included early active motion, either active flexion and extension or place and active hold, versus early passive motion using the Kleinert protocol or a modification of the Kleinert protocol, the Duran protocol and . A good understanding of the treatment procedures, healing . Tap again to see term . An infrequently mentioned explanation as to this it is writing to fully extend the fingers with severe wrist at zero degrees extension is the protective action all the lumbrical muscle. MODIFIED DURAN PROGRAM: FLEXOR TENDON REPAIR (ZONES I II III) DAY 2-3 Remove protective splint making sure to keep hand postured in a protective position. Paul R. Manske. analysed differences in range of motion between the various rehabilitation protocols. Click card to see definition . 6 Weeeks Postop The dorsal blocking splint Is discontinued. Various protocols for trout after flexor tendon repair are ongoing Each protocol must cram into consideration the stress placed on flexor. Day 3-5 Post Op - 3 1/2 weeks Post op - Edema control -- elevation, compression wrap - Immobilization: DBS - wrist in 20 neutral, MCP in 70 degrees of flexion, IP's in full extension (unless digital nerve is repaired) Most users should sign go with their email address. Paperback. The median relative flexor digitorum profundus tendon excursions were 11.2, 8.5, 7.2, 10.4, and 5.6 mm for the active four-finger mobilization protocol, the passive four-finger mobilization protocol, the modified Kleinert mobilization protocol, the experimental modified Kleinert flexion mobilization model, and the experimental modified Kleinert . After 3 weeks, the dorsal splint is removed and a wrist band with a hook for the rubber band is used for an additional 3 weeks. Frayed Tendon Protocol. Additionally, Chesney et al. Surgical reliease required. Add place/hold if not yet done via EAM. The mean rate of rupture was lowest in the combined Kleinert and Duran protocols (2.3 percent) and highest in the Kleinert protocols (7.1 percent). - Kleinert and Duran Protocols are the most common. Match. Static Progressive Splinting for Posttraumatic Elbow Stiffness. Kleinert protocol flexor tendon repair 4 . 4.8 out of 5 stars 8. 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