July 18, 2024

Modified Duran’s Protocol is the post-operative rehabilitation protocol after the repair of flexor tendon injuries.

Function of hand  in flexion following Duran's protocol
The function of hand in flexion following Duran’s protocol

Dorsal Blocking Splint (DBS):

Wrist– 20-degrees flexion

MPs– 70-degrees flexion

PIPs/ DIPs– full extension

The safe position of splintage of any joint is that in which the maximum number of ligaments are at a maximum tension (the closed packed position). The CAM shape of the metacarpal head produces maximum tension in the collateral ligaments in flexion (60 Degrees). Flexion of the PIP joint produces (flexible) part of the volar ligaments, which rapidly contracts, and a flexion contracture results. The DIP joint ligaments are maximally tense in extension. So, the safe position of splintage of the hand includes MCP joint flexion, with PIP and DIP joints in full extension.

Modified Duran’s protocol steps in subsequent postoperative days

3rd Post-Operative Day

  • Bulky dressing
  • PROM exercises are initiated within the restrain of DBS each [2 hr/day]
  • 25 repetitions of passive flexions and extensions of PIP, DIP, and entire digits

10th-14th Post-Operative day

  • Within 48 hr following suture removal scar massage with lotion can be initiated
  • PROM continued

31/2 weeks Post-Operative

  • PROM is continued
  • Active flexion and extension exercises may be initiated with the splint

4th-weeks Post-Operative

  • Neuromuscular electrical stimulation may be added to therapy after the patient is performing active flexion exercises for 3-5 days
  • USG may be added if the dense scar is present and/or limited tendon excursion is concerned

41/2 weeks Post-Operative

  • DBS is removed each hour/ two to begin
  • AROM exercises outside splint
  • Wrist and fingers flexion followed by their extension
  • Composite fist followed by MP extension with IP flexed followed by IP extension
  • Composite fist with wrist extension and flexion
  • DBS continued during exercises session and at night

51/2 weeks Post-Operative

  • DBS discontinued
  • AROM continues
  • Extension splint may be initiated in full active extension
  • Preferably worn at night only
  • In day buddy strapping with adjacent fingers

6-weeks Post-Operative

  • Passive extension exercises are initiated
  • A dynamic extension splint may be initiated if a PIP joint flexor contracture develops

8-weeks Post-Operative

  • Strengthening may be initiated to the hand beginning with a hand exerciser

10-12 weeks Post-Operative

  • All activities

14-16 weeks Post-Operative

  • Weight resistance to hand and extremity is permitted
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