Use of a relative motion flexion orthosis with dorsal hood to protect a middle phalanx finger fracture and zone III extensor tendon repair, while correcting a secondary fixed flexion proximal interphalangeal joint flexion contracture: A case report

Background: Proximal interphalangeal joint (PIPJ) contractures, zone III extensor tendon injuries and phalanx fractures are challenging to treat in isolation. In this case the patient presented with all 3 of these issues in a single digit, presenting a unique problem for the hand therapist. Purpose: A case report to examine the effectiveness of using single orthosis to treat an index finger following a combined zone III extension tendon repair, surgically stabilized second phalanx fracture and PIPJ flexion contracture. Methods: A patient presented to therapy with a 40 degrees PIPJ flexion contracture and minus 70 degrees of active PIPJ extension (ICD10 M25.64) after left index surgical fixation of a middle phalanx fracture (ICD10 S62.621B) and zone III extensor tendon repair (ICD10 S66.321A). To correct the contracture, a distal elastic strap was added to a relative motion flexion orthosis with dorsal hood. This applied a gentle extension force to the PIPJ. Once the contracture resolved a short arc motion program (SAM) was initiated using the same orthosis. Results: At 20 weeks post initial therapy evaluation, active range of motion (extension/flexion) of the PIPJ was 5 degrees/100 degrees and distal interphalangeal joint (DIPJ) 0 degrees/60 degrees. The Quick DASH score improved 50 points from an initial 59 points to 9 points. The patient reported good satisfaction and full function of the hand. Conclusion: Our case report demonstrated the effective use of a single relative motion flexion orthosis with a dorsal hood when treating a complex hand injury involving an open zone III injury, second phalanx fracture and 40-degree PIPJ contracture. (c) 2022 Elsevier Inc. All rights reserved.