Authors (including presenting author) :
Lam YC, Lui WY, Wong MF, Hui N
Affiliation :
Occupational Therapy Dept., United Christian Hospital
Introduction :
Early passive motion (EPM) protocols were widely used in the past after flexor tendon repair. Most of these protocols advocated immediate passive mobilization using a dynamic splint (Kleinert splint) that allowed active digit extension to produce recoil on an attached rubber band, with resulting passive flexion. However, splint fabrication was time consuming, while application of false nail, a constant pull from a rubber band and the awkward positioning caused discomfort to patients. It also made the process of wound dressing become redundant. Higgins and Lalonde proposed the Saint John protocol in 2016, which is a flexor tendon rehabilitation program using the early active motion (EAM) approach. This leads us to shift from the EPM protocol to the Saint John protocol in 2021. Our setting is the first public hospital to adopt this protocol with satisfactory outcomes yielded.
Objectives :
To summarize the clinical pearls and practical techniques and review the effectiveness of the Saint John protocol after flexor tendon repair
Methodology :
In the Saint John protocol, static splint without dynamic component is adopted. At day 2 after the surgery, protective cast is removed and a forearm wrist extension splint is fitted. In order to ease patient’s worries and discomfort, as well as avoiding unnecessary stretch to the injured tendon, a moulding aid was used. The splint is then adjusted to a short Manchester splint from week 3. To facilitate home program, an instruction sheet on splint and exercise regime, and a video on splint care was compiled.
Result & Outcome :
From November 2021 to November 2024, the Saint John protocol was adopted among a total of 33 patients with repaired finger flexors. The splint fabrication time was shortened, while patients showed good compliance and satisfaction to the intervention.
A retrospective study also revealed that from 2021 to 2023, 15 patients with zone I to II flexors repaired using the Saint John protocol in our setting resulted in significantly less pain, less PIPJ flexion contracture and earlier return to work rate, compared to the early passive protocol group (Ho & Chow, 2024). The re-rupture rates of both groups are similar.
The Saint John protocol shortens the splint fabrication time and the simple design allows therapists to take up the techniques quicker. The splint places a patient’s hand and wrist in a more comfortable resting position. Without the constant pull of rubber band, it facilitates the circulation of hand and reduces swelling. With satisfactory clinical outcomes yielded, the Saint John protocol enhances both efficiency of service and quality of care. It is continually adopted among patients with zone I to IV fingers flexor repaired in our setting.
