Advertisement

Complications and Clinical Outcomes Following Zone I Flexor Tendon Repair Using All-Inside Suture Fixation

Published:October 03, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.08.006

      Purpose

      The purpose of this study was to evaluate complications and outcomes of an all-inside repair technique for flexor digitorum profundus (FDP) avulsions.

      Methods

      A retrospective review of a single institution database identified all FDP avulsions that were repaired using an all-inside technique by a single surgeon. In this method, 2 Keith needles are drilled from the volar to dorsal aspect, exiting proximal to the nail matrix and within the extensor tendon. Nonabsorbable sutures were placed in the flexor tendon and passed through the bone tunnels, tying dorsally over the distal phalanx. The demographics characteristics, injury characteristics, the surgical procedure, postoperative complications, and outcomes were reviewed.

      Results

      Seventeen patients were included in the study. The average age was 40 years (range, 21–68 years), and 2 patients were women. Seventeen fingers were included: 14 ring fingers, 1 index finger, and 2 little fingers. Six patients had an associated distal phalanx fracture and one had an associated distal interphalangeal joint dislocation. The average time between injury and surgery was 9 days (range, 2–18 days). Four patients had complications: 3 with erythema related to infection, which appeared to be a reaction to the suture prompting removal, and 1 with a subungual mass related to the suture at removal. One patient had persistent pain. Postoperative range of motion, assessed using the Strickland criteria, was excellent or good in 5 (33%) of 15 patients, but this was predominantly due to motion at the proximal joints as overall DIP motion was limited. Patients had a mean distal interphalangeal joint range of motion of 24° (range, 0° to 55°).

      Conclusions

      In our series, repair of FDP avulsions via all-inside suture fixation is associated with limited distal interphalangeal joint motion and an incidence of infection (24%) at final follow-up.

      Type of study/level of evidence

      Therapeutic V.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ruchelsman D.E.
        • Christoforou D.
        • Wasserman B.
        • Lee S.K.
        • Rettig M.E.
        Avulsion injuries of the flexor digitorum profundus tendon.
        J Am Acad Orthop Surg. 2011; 19: 152-162
        • Strickland J.W.
        The scientific basis for advances in flexor tendon surgery.
        J Hand Ther. 2005; 18: 94-111
        • Ishak A.
        • Rajangam A.
        • Khajuria A.
        The evidence-base for the management of flexor tendon injuries of the hand: review.
        Ann Med Surg (Lond). 2019; 48: 1-6
        • Kang N.
        • Marsh D.
        • Dewar D.
        The morbidity of the button-over-nail technique for zone 1 flexor tendon repairs. Should we still be using this technique?.
        J Hand Surg Eur Vol. 2008; 33: 566-570
        • Huq S.
        • George S.
        • Boyce D.E.
        Zone 1 flexor tendon injuries: a review of the current treatment options for acute injuries.
        J Plast Reconstr Aesthet Surg. 2013; 66: 1023-1031
        • Katolik L.I.
        • Friedrich J.
        • Trumble T.E.
        Repair of acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint: a retrospective comparison of pull-out sutures and bone anchor techniques.
        Plast Reconstr Surg. 2008; 122: 1451-1456
        • Brustein M.
        • Pellegrini J.
        • Choueka J.
        • Heminger H.
        • Mass D.
        Bone suture anchors versus the pullout button for repair of distal profundus tendon injuries: a comparison of strength in human cadaveric hands.
        J Hand Surg Am. 2001; 26: 489-496
        • Moiemen N.S.
        • Elliot D.
        Primary flexor tendon repair in zone 1.
        J Hand Surg Br. 2000; 25: 78-84
        • Chu J.Y.
        • Chen T.
        • Awad H.A.
        • Elfar J.
        • Hammert W.C.
        Comparison of an all-inside suture technique with traditional pull-out suture and suture anchor repair techniques for flexor digitorum profundus attachment to bone.
        J Hand Surg Am. 2013; 38: 1084-1090
        • Patrick N.
        • Weinheimer K.
        • Darowish M.
        A novel technique for the treatment of Jersey fingers.
        Am J Orthop (Belle Mead NJ). 2018; 47https://doi.org/10.12788/ajo.2018.0026
        • Geary M.B.
        • Li K.K.
        • Chadderdon R.C.
        • Gaston R.G.
        Complications following transosseous repair of zone I flexor tendon injuries.
        J Hand Surg Am. 2020; 45: 1183.e1-1183.e7
        • Strickland J.W.
        Flexor tendon repair.
        Hand Clin. 1985; 1: 55-68
        • Howard R.F.
        • Ondrovic L.
        • Greenwald D.P.
        Biomechanical analysis of four-strand extensor tendon repair techniques.
        J Hand Surg Am. 1997; 22: 838-842
        • Leddy J.P.
        • Packer J.W.
        Avulsion of the profundus tendon insertion in athletes.
        J Hand Surg Am. 1977; 2: 66-69
        • Guinard D.
        • Montanier F.
        • Thomas D.
        • Corcella D.
        • Moutet F.
        The Mantero flexor tendon repair in zone 1.
        J Hand Surg Br. 1999; 24: 148-151
        • McCallister W.V.
        • Ambrose H.C.
        • Katolik L.I.
        • Trumble T.E.
        Comparison of pullout button versus suture anchor for zone I flexor tendon repair.
        J Hand Surg Am. 2006; 31: 246-251
        • Teo T.C.
        • Dionyssiou D.
        • Armenio A.
        • Ng D.
        • Skillman J.
        Anatomical repair of zone 1 flexor tendon injuries.
        Plast Reconstr Surg. 2009; 123: 617-622
        • Sood M.K.
        • Elliot D.
        A new technique of attachment of flexor tendons to the distal phalanx without a button tie-over.
        J Hand Surg Br. 1996; 21: 629-632
        • Evans R.B.
        Zone I flexor tendon rehabilitation with limited extension and active flexion.
        J Hand Ther. 2005; 18: 128-140
        • Schaller P.
        • Baer W.
        Motion-stable flexor tendon repair with the Mantero technique in the distal part of the fingers.
        J Hand Surg Eur Vol. 2010; 35: 51-55
        • Trumble T.E.
        • Vedder N.B.
        • Seiler III, J.G.
        • Hanel D.P.
        • Diao E.
        • Pettrone S.
        Zone-II flexor tendon repair: a randomized prospective trial of active place-and-hold therapy compared with passive motion therapy.
        J Bone Joint Surg Am. 2010; 92: 1381-1389
      1. Compton J, Wall LB, Romans B, Goldfarb CA. Outcomes of acute repair versus nonrepair of zone i flexor digitorum profundus tendon injuries. J Hand Surg Am. Published online April 9, 2022. https://doi.org/10.1016/j.jhsa.2022.02.005