Abstract
This article describes a splint management program for zone 4–7 extensor tendon repairs
that allows for immediate controlled active motion (ICAM) of the repair and greater
arcs of motion for adjacent digits. The splint is designed to relieve tension on the
tenorrhaphy by positioning the involved digit in slight metacarpophalangeal joint
hyperextension relative to the uninvolved digits with a simple yoke splint designed
to control the metacarpophalangeal joints and a second splint to control wrist position.
Cadaver and intraoperative trials support this technique, and 140 patient cases managed
over 20 years. The majority of patients achieved a rating of excellent for both digital
extension and flexion as judged by Miller's criteria. There were very few extension
lags and no tendon ruptures. Patients returned to work in the ICAM splint on average
in 18 days. The average time to complete the program was seven weeks after repair,
and required an average of eight therapy visits. The results of this study demonstrate
that the ICAM splinting technique is safe, simple to manage, decreases the morbidity
associated with immobilization, is cost effective, and has high patient compliance
when compared to other early motion programs.
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© 2005 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
