Differential Splinting After Zone II Flexor Tendon Repair: The Bidirectional Splint.
- 1From the Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut, Beirut, Lebanon.
- 2European University School of Medicine, Tbilisi, Georgia.
Abstract
Background
Zone II flexor tendon injuries remain challenging because of the risks of rupture, adhesions, and stiffness. Splint design may influence repair-site tension during early healing. We describe a novel bidirectional splint (B-splint) that applies differential tensioning and compare its outcomes with those of conventional dorsal blocking splinting.Methods
We retrospectively studied 59 patients (99 repaired tendons): 20 patients (31 tendons) treated with the B-splint after flexor digitorum profundus repair and 39 patients (68 tendons) treated with a dorsal blocking splint. The B-splint positions repaired digits in metacarpophalangeal flexion with interphalangeal extension while maintaining the noninjured digits in full extension. Functional outcomes were assessed using the modified Strickland score; tendon rupture and tenolysis were recorded. Categorical outcomes were compared using exact tests.Results
No ruptures occurred in the B-splint cohort versus 1 in the control cohort. Excellent outcomes occurred in 19 of 20 B-splint patients (95%) versus 30 of 39 controls (77%), favoring the B-splint without statistical significance (P = 0.141). Tenolysis was less frequent with the B-splint (5% versus 13%). No B-splint patients developed stiffness of the noninjured digits.Conclusions
The B-splint was associated with favorable functional outcomes, no observed ruptures, and less tenolysis than conventional dorsal blocking splinting. It complements established rehabilitation strategies. Prospective studies are warranted to define its biomechanical and clinical role.
Related
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- Minimally Invasive Revision Surgery Combining Endoscopic Double-Row Reinsertion and Flexor Hallucis Longus Transfer for Insertional Achilles Tendon Re-Rupture in a Semi-Professional Rugby Player: A Case Report
BibTeX
@article{bakhach2026differential,
title = {{Differential Splinting After Zone II Flexor Tendon Repair: The Bidirectional Splint.}},
author = {Joseph Bakhach and Dimitri Bakhach and Tarek El Hachem and Jana Baajour and Jana Doghman and Oussama Issa and Charbel Macaron and Diya' S Hammoudeh},
journal = {Plastic and reconstructive surgery. Global open},
year = {2026},
month = oct,
doi = {10.1097/gox.0000000000008212},
url = {https://europepmc.org/article/MED/42921370},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Differential Splinting After Zone II Flexor Tendon Repair: The Bidirectional Splint.
AU - Joseph Bakhach
AU - Dimitri Bakhach
AU - Tarek El Hachem
AU - Jana Baajour
AU - Jana Doghman
AU - Oussama Issa
AU - Charbel Macaron
AU - Diya' S Hammoudeh
PY - 2026
DA - 2026/10/23
JO - Plastic and reconstructive surgery. Global open
DO - 10.1097/gox.0000000000008212
UR - https://europepmc.org/article/MED/42921370
AB - Background Zone II flexor tendon injuries remain challenging because of the risks of rupture, adhesions, and stiffness. Splint design may influence repair-site tension during early healing. We describe a novel bidirectional splint (B-splint) that applies differential tensioning and compare its outcomes with those of conventional dorsal blocking splinting.Methods We retrospectively studied 59 patients (99 repaired tendons): 20 patients (31 tendons) treated with the B-splint after flexor digitorum profundus repair and 39 patients (68 tendons) treated with a dorsal blocking splint. The B-splint positions repaired digits in metacarpophalangeal flexion with interphalangeal extension while maintaining the noninjured digits in full extension. Functional outcomes were assessed using the modified Strickland score; tendon rupture and tenolysis were recorded. Categorical outcomes were compared using exact tests.Results No ruptures occurred in the B-splint cohort versus 1 in the control cohort. Excellent outcomes occurred in 19 of 20 B-splint patients (95%) versus 30 of 39 controls (77%), favoring the B-splint without statistical significance (P = 0.141). Tenolysis was less frequent with the B-splint (5% versus 13%). No B-splint patients developed stiffness of the noninjured digits.Conclusions The B-splint was associated with favorable functional outcomes, no observed ruptures, and less tenolysis than conventional dorsal blocking splinting. It complements established rehabilitation strategies. Prospective studies are warranted to define its biomechanical and clinical role.
SN - 2169-7574
ER -