A Double Reverse Kleinert ExtensionSplint 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 takesecond 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. Thisauthor has developed a splint that encourages this process.—PEGGY L. FILLION, OTR, CHT, Practice Forum Editor

PRACTICE FORUM

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A DOUBLE REVERSE KLEINERTSPLINT FOR EXTENSOR TENDONREPAIRS IN ZONES VI TO VIII

Shrikant Chinchalkar, OTR, CHTSean Ah Yong, OTR, MSc (OT)Hand and Upper Limb CentreSt. Joseph’s Health Care LondonLondon, Ontario, Canada

Early controlled active mobilization for extensortendon injuries is well supported as the method oftreatment after surgical tendon repair.1–4 There aremany clinical complications associated with ex-tensor tendons treated with immobilization, in-cluding adherent tendons, loss of digital flexion,extensor lag, joint contractures, and prolongedtreatment time.2,3 Extensor tendon injuries inzones 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 theconventional principles of Kleinert and may min-imize the number of complications associatedwith

Correspondence and reprint requests to Shrikant Chinchalkar,OTR, CHT, Hand and Upper Limb Centre, St. Joseph’s HealthCare London, 268 Grosvenor Street, London, Ontario, N6A 4L6.e-mail: ,Shrikant.Chinchalkar@sjhc.london.on.ca..

doi:10.1197/j.jht.2004.07.006

24 JOURNAL OF HAND THERAPY

immobilization of the wrist. The splint is designedto promote increased tendon gliding through theextensor 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-inchthickness (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 loopstraps (for the forearm component)

8. Two self-adhesive Velcro hooks, approxi-mately 1 3 1 inch (for the hand component)

9. One 1-inch-wide nonadhesive Velcro loopstrap (to close the hand component)

10. Five regular elastic bands, one for the wristand 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 distalend is proximal and flared to accommodate for theulnar and radial styloids and the length of thiscomponent should be approximately two thirdsthe length of the forearm.

Figure 1. Materials required for splint fabrication.

Figure 2. The hand component and forearm component.

Figure 3. The incremental wrist hinge placed on ulnar andradial aspect of wrist.

Figure 4. Splint with rubber band posts to provide rubberband assisted wrist extension.

Figure 5. Splint with Velcro straps and rubber band in place.

October–December 2004 425

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For the hand component. Measure the circumfer-ence of the hand at the level of the distal palmarcrease. Ensure that you allow for a trap-door styleof closure.

Place one rubber band post on the hand com-ponent, centered on the third metacarpal. Placeanother rubber band post on the distal end of theforearm component aligned with the third meta-carpal. These will act as the anchors for the elasticsthat will assist with passive wrist extension.

Mount the incremental wrist hinges. Ensure theleft and right wrist hinges are mounted on thelateral aspects of the hand and forearm compo-nents, allowing for unrestricted wrist flexion/extension. Adjust wrist flexion block on wrist

Figure 6. Finished splint demonstrating wrist flexion block.

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hinge to limit wrist flexion. Mount the outriggeron the hand component using two rubber bandposts, and ensure each pulley is centered on theappropriate digit.

Place the remaining two rubber band posts atthe proximal end of the forearm component. Thesewill act as the anchors for the elastics attached tothe finger saddle slings.

Apply Velcro pieces accordingly. Measure theVelcro strap length required for the patient.

Place the finger saddle slings on the outriggerand attached rubber bands. Attach line locs to limitmetacarpophalangeal (MCP) flexion.

Once the splint is on the patient, attach rubberbands to the corresponding rubber band posts.

Considerations

Thorough discussion and consultation with thehand surgeon should be completed regardinglimitations in wrist flexion and digital flexionand surgical repair details. Wrist joint flexionmay be limited between 0 and 10 degrees initially,and then gradually progress 10 degrees eachweek.The adjustable hinges allow for wrist flexion to belimited postoperatively followed by a gradual in-crease as rehabilitation progresses.

MCP joint flexion may be limited to 30 degreesinitially, and then gradually progress 15 degreeseach week. The line locs allow for MCP flexion tobe 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 proximalto the metacarpophalangeal joints. Hand Clin. 1995;11:403–10.

2. Crosby CA, Wehbe MA. Early motion after extensor tendonsurgery. Hand Clin. 1996;12:57–64.

3. Evans RB. Immediate active short arc motion followingextensor tendon repair. Hand Clin. 1995;11:483–512.

4. Rosenthal EA. The extensor tendons: anatomy and manage-ment. In: Mackin EJ, Callahan AD, Skirven TM, SchneiderLH, Osterman AL (eds). Rehabilitation of the Hand andUpper Extremity. 5th ed. St. Louis: Mosby, 2002. p 498–541.