Skip to main content
SpringerLink
Log in

Therapiestandards nach Beugesehnen- und Nervenverletzungen der Hand

Ergebnisse einer Umfrage zur Immobilisationsdauer unter deutschen handchirurgischen Zentren

Therapy standards after flexor tendon and nerve injuries of the hand

Results from a survey of German centres for hand surgery

  • Originalien
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Zur Nachbehandlung kombinierter Verletzungen von Beugesehnen und Nerven der Hand finden sich keine einheitlichen Empfehlungen. Ziel dieser Studie ist ein Vergleich der individuellen Therapiestandards deutscher handchirurgischer Zentren zur Immobilisationsdauer bei isolierten und kombinierten Verletzungen.

Methoden

Die Datenerhebung erfolgte über einen an alle Mitglieder der Deutschen Gesellschaft für Handchirurgie (DGH), Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) und der Sektion Handchirurgie der Deutschen Gesellschaft für Unfallchirurgie (DGU) versandten Fragebogen.

Ergebnisse

Isolierte Beugesehnenverletzungen der Zonen II–IV werden von allen befragten Zentren frühdynamisch nachbehandelt, isolierte Digitalnervenverletzungen aber meist mit einer Immobilisation (10% keine Ruhigstellung, 22,5% bis zu einer Woche, 52,5 bzw. 15% 2 oder 3 Wochen). Sie verlängert sich bei Läsionen der Nn. medianus oder ulnaris um etwa eine Woche. Bei kombinierten Verletzungen sprachen sich 55% für eine unverzögerte dynamische Nachbehandlung aus.

Schlussfolgerung

Wir fanden keine einheitlichen Behandlungsvorgaben für kombinierte Beugesehnen- und Nervenverletzungen. Vor dem Hintergrund der aktuellen Literatur scheint eine frühdynamische Nachbehandlung auch bei begleitender Nervenverletzung gerechtfertigt.

Abstract

Background

There is little evidence for the ideal aftercare of combined nerve and flexor tendon injuries of the hand. The aim of this study was to elicit whether concomitant nerve injuries are changing the individual treatment plans after flexor tendon repair in a survey of German centres for hand surgery.

Methods

A questionnaire about aftercare of isolated and combined nerve and flexor tendon injuries of the hand was distributed to members of three German Societies of hand, trauma and plastic surgery.

Results

Isolated flexor tendon injuries in zones II to IV are treated by early mobilization in all centres, whereas isolated digital nerve repair is usually followed by immobilization (10% no immobilization, 22.5% up to 1 week, 52.5% for 2 weeks and 15% for 3 weeks). The duration of immobilization increases with lesions of the median or ulnar nerves by about 1 week. In 55% of cases concomitant nerve injury does not influence the early onset of dynamic splinting and mobilization after flexor tendon injuries.

Conclusion

There seem to be no uniform treatment guidelines for flexor tendon repair if concomitant nerve injury is present. Against the background of the current literature early controlled mobilization after tendon and nerve repair seems to be justified.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Aoki M, Kubota H, Pruitt DL et al (1997) Biomechanical and histologic characteristics of canine flexor tendon repair using early postoperative mobilization. J Hand Surg [Am] 22:107–114

    Google Scholar 

  2. Berndtsson L, Ejeskar A (1995) Zone II flexor tendon repair in children. A retrospective long term study. Scand J Plast Reconstr Surg Hand Surg 29:59–64

    Article  CAS  PubMed  Google Scholar 

  3. Birch R (1986) Lesions of peripheral nerves: the present position. J Bone Joint Surg [Br] 68:2–8

    Google Scholar 

  4. Birch R (2005) Nerve repair. In: Green D, Pederson WC, Hotchkiss R, Wolfe SW (eds) Greens operative hand surgery, chapter 30. 5th edn. Churchill Livingstone, Edinburgh, pp 1075–1112

  5. Boyer MI, Strickland JW, Engles D et al (2003) Flexor tendon repair and rehabilitation: state of the art in 2002. Instr Course Lect 52:137–161

    PubMed  Google Scholar 

  6. Chao RP, Braun SA, Ta KT et al (2001) Early passive mobilization after digital nerve repair and grafting in a fresh cadaver. Plast Reconstr Surg 108:386–391

    Article  CAS  PubMed  Google Scholar 

  7. Clare TD, de Haviland MS, Belcher HJ (2004) Rehabilitation of digital nerve repair: is splinting necessary? J Hand Surg [Br] 29:552–556

    Google Scholar 

  8. Creekmore H, Bellinghausen H, Young VL et al (1985) Comparison of early passive motion and immobilization after flexor tendon repairs. Plast Reconstr Surg 75:75–79

    Article  CAS  PubMed  Google Scholar 

  9. Elhassan B, Moran SL, Bravo C et al (2006) Factors that influence the outcome of zone I and zone II flexor tendon repairs in children. J Hand Surg [Am] 31:1661–1666

    Google Scholar 

  10. Feehan LM, Beauchene JG (1990) Early tensile properties of healing chicken flexor tendons: early controlled passive motion versus postoperative immobilization. J Hand Surg [Am] 15:63–68

    Google Scholar 

  11. Gelberman RH, Botte MJ, Spiegelman JJ et al (1986) The excursion and deformation of repaired flexor tendons treated with protected early motion. J Hand Surg [Am] 11:106–110

    Google Scholar 

  12. Goldberg SH, Jobin CM, Hayes AG et al (2007) Biomechanics and histology of intact and repaired digital nerves: an in vitro study. J Hand Surg [Am] 32:474–482

    Google Scholar 

  13. Kim HK, Kerr RG, Turley CB et al (1998) The effects of postoperative continuous passive motion on peripheral nerve repair and regeneration. An experimental investigation in rabbits. J Hand Surg [Br] 23:594–597

    Google Scholar 

  14. Lee WP, Constantinescu MA, Butler PE (1999) Effect of early mobilization on healing of nerve repair: histologic observations in a canine model. Plast Reconstr Surg 104:1718–1725

    Article  CAS  PubMed  Google Scholar 

  15. Lister GD, Kleinert HE, Kutz JE et al (1977) Primary flexor tendon repair followed by immediate controlled mobilization. J Hand Surg [Am] 2:441–451

    Google Scholar 

  16. Lohmeyer JA, Essmann E, Richerson SJ et al (2008) Use of erythropoietin as adjuvant therapy in nerve reconstruction. Langenbecks Arch Surg 393:317–323

    Article  CAS  PubMed  Google Scholar 

  17. Lohmeyer JA, Shen ZL, Walter GF et al (2007) Bridging extended nerve defects with an artifcial nerve graft containing Schwann cells pre-seeded on polyglactin filaments. Int J Artif Organs 30:64–74

    CAS  PubMed  Google Scholar 

  18. Malczewski MC, Zamboni WA, Haws MJ et al (1995) Effect of motion on digital nerve repair in a fresh cadaver model. Plast Reconstr Surg 96:1672–1675

    Article  CAS  PubMed  Google Scholar 

  19. Millesi H (1985) Peripheral nerve repair: terminology, questions, and facts. J Reconstr Microsurg 2:21–31

    Article  CAS  PubMed  Google Scholar 

  20. Millesi H (2000) Techniques for nerve grafting. Hand Clin 16:73–91, viii

    CAS  PubMed  Google Scholar 

  21. Nietosvaara Y, Lindfors NC, Palmu S et al (2007) Flexor tendon injuries in pediatric patients. J Hand Surg [Am] 32:1549–1557

    Google Scholar 

  22. Schmidhammer R, Zandieh S, Hopf R et al (2004) Alleviated tension at the repair site enhances functional regeneration: the effect of full range of motion mobilization on the regeneration of peripheral nerves – histologic, electrophysiologic, and functional results in a rat model. J Trauma 56:571–584

    Article  PubMed  Google Scholar 

  23. Stephan C, Saalabian A, van Schoonhoven J et al (2008) Acute flexor tendon surgery. Oper Orthop Traumatol 20:44–54

    Article  PubMed  Google Scholar 

  24. Strickland JW, Glogovac SV (1980) Digital function following flexor tendon repair in zone II: a comparison of immobilization and controlled passive motion techniques. J Hand Surg [Am] 5:537–543

    Google Scholar 

  25. Terzis J, Faibisoff B, Williams B (1975) The nerve gap: suture under tension vs. graft. Plast Reconstr Surg 56:166–170

    Article  CAS  PubMed  Google Scholar 

  26. Thien TB, Becker JH, Theis JC (2004) Rehabilitation after surgery for flexor tendon injuries in the hand. Cochrane Database Syst Rev CD003979

  27. Vipond N, Taylor W, Rider M (2007) Postoperative splinting for isolated digital nerve injuries in the hand. J Hand Ther 20:222–230

    Article  PubMed  Google Scholar 

  28. Werber KD (2005) Flexor tendon injuries of the hand. Unfallchirurg 108:873–881

    Article  CAS  PubMed  Google Scholar 

  29. Yu RS, Catalano LW III, Barron OA et al (2004) Limited, protected postsurgical motion does not affect the results of digital nerve repair. J Hand Surg [Am] 29:302–306

    Google Scholar 

Download references

Danksagung

Wir danken herzlich allen beteiligten Zentren für ihre Teilnahme an dieser Studie.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    J.A. Lohmeyer

  2. Plastische Chirurgie, Handchirurgie, Intensiveinheit für Schwerbrandverletzte, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland

    J.A. Lohmeyer, F. Siemers & P. Mailänder

Authors
  1. J.A. Lohmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Siemers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Mailänder
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J.A. Lohmeyer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lohmeyer, J., Siemers, F. & Mailänder, P. Therapiestandards nach Beugesehnen- und Nervenverletzungen der Hand. Unfallchirurg 113, 203–209 (2010). https://doi.org/10.1007/s00113-009-1692-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-009-1692-0

Schlüsselwörter

Keywords

Search

Navigation