FUNCTIONAL RESULTS OF DYNAMIC SPLINTING AFTER TRANSMETACARPAL, WRIST,AND DISTAL FOREARM REPLANTATION

The results of replantation at the wrist and distal forearm are report ed to be better than at the metacarpal level, in part because the latt er involve direct injury to the intrinsic muscles, This study evaluate s a new post-operative protocol for replantation at the metacarpal, wr ist and distal forearm levels, 3 days after replantation, the patient was placed in a dynamic crane outrigger splint with MP joint control, compensating for intrinsic muscle function loss. From 3 to 12 weeks, a n anticlaw splint alternated with the outrigger splint. After 12 weeks , a dynamic wrist extension orthosis was added to the anti-claw splint . 11 patients (four replantations at the transmetacarpal level, three at the wrist and four in the distal forearm) had this protocol between 1988 and 1993, For distal forearm replantation, TAM of fingers averag ed 216 degrees, grip strength 42 lb, and pinch strength 7.2 lb with 75 % good or excellent results, For wrist replantations, TAM of fingers a veraged 243 degrees, grip strength 37 lb and pinch strength 10.6 lb wi th 100% good or excellent results, For transmetacarpal replantations, TAM of fingers averaged 189 degrees, grip strength 37 lb and pinch str ength 5.6 lb, with 75% good and excellent results. Early protected mob ilization, as described here, preserves tendon gliding, muscle strengt h and excursion. Our results support this protocol for wrist and dista l forearm replantation and especially for transmetacarpal replantation , the results of which tend to be poor according to the medical litera ture.