This 1977 study by Lister, Kleinert, and colleagues reports outcomes of primary flexor tendon repair combined with immediate postoperative dynamic splinting in 60 patients with 140 tendon injuries. The central question: can early controlled motion prevent adhesions in zone II without disrupting the repair? Results span zones I–IV with particular focus on the historically challenging 'no man's land' region.
The dominant teaching before this paper was that tendons in zone II should not be repaired primarily — Bunnell himself called it 'no man's land' because adhesion formation was considered inevitable. This paper, reporting Kleinert's 20-year experience, provided the outcome data that changed that doctrine.
When you see a zone II flexor tendon laceration, primary repair of both FDS and FDP followed by immediate dynamic splinting is the standard of care. Excising the FDS to simplify the repair cuts your excellent/good rate nearly in half (85.7% down to 42.9%). The complexity of repairing both slips is worth it.
The Kleinert splint works because active extension against rubber bands produces zero FDP EMG activity, and passive return to flexion generates negligible tendon force. This is not just compliance theater. It is the biomechanical reason the repair survives early motion.
Familiarize yourself with the splint position (wrist 20° from full flexion, MCP 20° flexion, IP 10° flexion) and the 3-week splint / 2-week wrap rehabilitation timeline. These numbers appear on boards.
This 1977 study by Lister, Kleinert, and colleagues reports outcomes of primary flexor tendon repair combined with immediate postoperative dynamic splinting in 60 patients with 140 tendon injuries. The central question: can early controlled motion prevent adhesions in zone II without disrupting the repair? Results span zones I–IV with particular focus on the historically challenging 'no man's land' region.
The dominant teaching before this paper was that tendons in zone II should not be repaired primarily — Bunnell himself called it 'no man's land' because adhesion formation was considered inevitable. This paper, reporting Kleinert's 20-year experience, provided the outcome data that changed that doctrine.
When you see a zone II flexor tendon laceration, primary repair of both FDS and FDP followed by immediate dynamic splinting is the standard of care. Excising the FDS to simplify the repair cuts your excellent/good rate nearly in half (85.7% down to 42.9%). The complexity of repairing both slips is worth it.
The Kleinert splint works because active extension against rubber bands produces zero FDP EMG activity, and passive return to flexion generates negligible tendon force. This is not just compliance theater. It is the biomechanical reason the repair survives early motion.
Familiarize yourself with the splint position (wrist 20° from full flexion, MCP 20° flexion, IP 10° flexion) and the 3-week splint / 2-week wrap rehabilitation timeline. These numbers appear on boards.