A Double Reverse Kleinert Extension

Splint for Extensor Tendon Repairs in

Zones VI to VIII
When one compares an injury to the flexor tendons versus the extensor tendons, the extensor tendons frequently take
second place. We might find ourselves saying to our patients that they should do just fine and downplay their injury.
However, the truth of the matter is that any tendon injury needs to be able to glide to help prevent adhesions. This
author has developed a splint that encourages this process.PEGGY L. FILLION, OTR, CHT, Practice Forum Editor
A DOUBLE REVERSE KLEINERT
SPLINT FOR EXTENSOR TENDON
REPAIRS IN ZONES VI TO VIII
Shrikant Chinchalkar, OTR, CHT
Sean Ah Yong, OTR, MSc (OT)
Hand and Upper Limb Centre
St. Josephs Health Care London
London, Ontario, Canada
Early controlled active mobilization for extensor
tendon injuries is well supported as the method of
treatment after surgical tendon repair.
14
There are
many clinical complications associated with ex-
tensor tendons treated with immobilization, in-
cluding adherent tendons, loss of digital flexion,
extensor lag, joint contractures, and prolonged
treatment time.
2,3
Extensor tendon injuries in
zones VI, VII, and VIII require careful consider-
ation of the extensor tendon anatomy, physiology,
and biomechanics to minimize postoperative com-
plications.
1,4
Purpose
The Double Reverse Kleinert splint follows the
conventional principles of Kleinert and may min-
imize the number of complications associated with
immobilization of the wrist. The splint is designed
to promote increased tendon gliding through the
extensor retinaculum and the associated sheaths.
Materials
1. Adjustable outrigger for extension (low pro-
file; Rolyan)
2. Incremental wrist hinges, right and left
(Rolyan)
3. Perforated Aquaplast-T, preferably 1/8-inch
thickness (Rolyan)
4. One set of 2.5-inch saddle sling finger-adjust-
able finger loops (Smith and Nephew)
5. Four line locs/guides (Sammons Preston)
6. Four self-adhesive Velcro hooks, approxi-
mately 2 3 2 inches (for the forearm compo-
nent)
7. Two 2-inch-wide nonadhesive Velcro loop
straps (for the forearm component)
8. Two self-adhesive Velcro hooks, approxi-
mately 1 31 inch (for the hand component)
9. One 1-inch-wide nonadhesive Velcro loop
strap (to close the hand component)
10. Five regular elastic bands, one for the wrist
and four for the finger saddle slings
11. Six rubber band posts (Smith and Nephew)
12. Measuring tape
Fabrication
For the dorsal forearm component. Ensure the distal
end is proximal and flared to accommodate for the
ulnar and radial styloids and the length of this
component should be approximately two thirds
the length of the forearm.
PRACTICE FORUM
Correspondence and reprint requests to Shrikant Chinchalkar,
OTR, CHT, Hand and Upper Limb Centre, St. Josephs Health
Care London, 268 Grosvenor Street, London, Ontario, N6A4L6.
e-mail: ,Shrikant.Chinchalkar@sjhc.london.on.ca..
doi:10.1197/j.jht.2004.07.006
424 JOURNAL OF HAND THERAPY
Figure 1. Materials required for splint fabrication.
Figure 2. The hand component and forearm component.
Figure 3. The incremental wrist hinge placed on ulnar and
radial aspect of wrist.
Figure 4. Splint with rubber band posts to provide rubber
band assisted wrist extension.
Figure 5. Splint with Velcro straps and rubber band in place.
OctoberDecember 2004 425
For the hand component. Measure the circumfer-
ence of the hand at the level of the distal palmar
crease. Ensure that you allow for a trap-door style
of closure.
Place one rubber band post on the hand com-
ponent, centered on the third metacarpal. Place
another rubber band post on the distal end of the
forearm component aligned with the third meta-
carpal. These will act as the anchors for the elastics
that will assist with passive wrist extension.
Mount the incremental wrist hinges. Ensure the
left and right wrist hinges are mounted on the
lateral aspects of the hand and forearm compo-
nents, allowing for unrestricted wrist flexion/
extension. Adjust wrist flexion block on wrist
hinge to limit wrist flexion. Mount the outrigger
on the hand component using two rubber band
posts, and ensure each pulley is centered on the
appropriate digit.
Place the remaining two rubber band posts at
the proximal end of the forearmcomponent. These
will act as the anchors for the elastics attached to
the finger saddle slings.
Apply Velcro pieces accordingly. Measure the
Velcro strap length required for the patient.
Place the finger saddle slings on the outrigger
and attached rubber bands. Attach line locs to limit
metacarpophalangeal (MCP) flexion.
Once the splint is on the patient, attach rubber
bands to the corresponding rubber band posts.
Considerations
Thorough discussion and consultation with the
hand surgeon should be completed regarding
limitations in wrist flexion and digital flexion
and surgical repair details. Wrist joint flexion
may be limited between 0 and 10 degrees initially,
and then gradually progress 10 degrees each week.
The adjustable hinges allow for wrist flexion to be
limited postoperatively followed by a gradual in-
crease as rehabilitation progresses.
MCP joint flexion may be limited to 30 degrees
initially, and then gradually progress 15 degrees
each week. The line locs allow for MCP flexion to
be limited.
The patient is instructed not to perform simul-
taneous wrist flexion and digital flexion postoper-
atively.
REFERENCES
1. Aulicino PL. Acute injuries of the extensor tendons proximal
to the metacarpophalangeal joints. Hand Clin. 1995;11:
40310.
2. Crosby CA, Wehbe MA. Early motion after extensor tendon
surgery. Hand Clin. 1996;12:5764.
3. Evans RB. Immediate active short arc motion following
extensor tendon repair. Hand Clin. 1995;11:483512.
4. Rosenthal EA. The extensor tendons: anatomy and manage-
ment. In: Mackin EJ, Callahan AD, Skirven TM, Schneider
LH, Osterman AL (eds). Rehabilitation of the Hand and
Upper Extremity. 5th ed. St. Louis: Mosby, 2002. p 498541.
Figure 6. Finished splint demonstrating wrist flexion block.
426 JOURNAL OF HAND THERAPY