Advertisement

The Evaluation of a Flexor Digitorum Profundus-to-Volar Plate Zone I Repair Versus Button Repair: An In vitro Biomechanics Study

  • Mohammad M. Haddara
    Affiliations
    Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, London, Ontario, Canada

    School of Biomedical Engineering, Western University, London, Ontario, Canada
    Search for articles by this author
  • Eric C. Mitchell
    Affiliations
    Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, London, Ontario, Canada

    Division of Plastic and Reconstructive Surgery
    Search for articles by this author
  • Joshua A. Gillis
    Affiliations
    Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, London, Ontario, Canada

    Division of Plastic and Reconstructive Surgery
    Search for articles by this author
  • Louis M. Ferreira
    Affiliations
    Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, London, Ontario, Canada

    School of Biomedical Engineering, Western University, London, Ontario, Canada

    Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
    Search for articles by this author
  • Nina Suh
    Correspondence
    Corresponding author: Nina Suh, MD, Department of Orthopaedics, Emory University, 21 Ortho Lane, Atlanta, GA 30329.
    Affiliations
    Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, London, Ontario, Canada

    School of Biomedical Engineering, Western University, London, Ontario, Canada

    Department of Orthopaedics, Emory University, Atlanta, GA
    Search for articles by this author
Published:October 25, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.09.006

      Purpose

      The purpose of the study was to evaluate joint kinematics and tendon work of flexion (WOF) following a flexor digitorum profundus (FDP)-to-volar plate (VP) repair technique relative to a pullout button for zone I flexor tendon injuries.

      Methods

      Fourteen digits were tested using an in vitro active finger motion simulator under 3 repaired conditions following a simulated zone I avulsion: button, FDP-VP, and “no slack” FDP-VP (corrected for additional VP length). Outcome metrics included active joint range of motion (ROM), fingertip strength, FDP and flexor digitorum superficialis tensile loads, and WOF.

      Results

      The button and FDP-VP techniques restored WOF to the intact condition for FDP and flexor digitorum superficialis. All repairs restored distal interphalangeal joint ROM and kinematics to the intact condition. Similarly, all repairs restored WOF; however, the “no slack” FDP-VP significantly increased WOF by 10% to 12% over the simple FDP-VP repair. The button technique had similar fingertip strength to the intact condition, whereas the FDP-VP repairs significantly reduced peak fingertip strength from intact, albeit only 1–2 N compared with the button repair.

      Conclusion

      In this in vitro cadaveric model, the button and FDP-VP techniques restored WOF and ROM to within intact levels, with no difference between these repairs in all measured outcome metrics.

      Clinical relevance

      Based on its initial strength and its equal biomechanical performance compared with the button repair, the FDP-VP technique may be a viable option for treating FDP avulsions.

      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

        • de Jong J.P.
        • Nguyen J.T.
        • Sonnema A.J.M.
        • Nguyen E.C.
        • Amadio P.C.
        • Moran S.L.
        The incidence of acute traumatic tendon injuries in the hand and wrist: a 10-year population-based study.
        Clin Orthop Surg. 2014; 6: 196-202
        • Brar R.
        • Owen J.R.
        • Melikian R.
        • Gaston R.G.
        • Wayne J.S.
        • Isaacs J.E.
        Reattachment of flexor digitorum profundus avulsion: biomechanical performance of 3 techniques.
        J Hand Surg Am. 2014; 39: 2214-2219
        • Tang J.B.
        Clinical outcomes associated with flexor tendon repair.
        Hand Clin. 2005; 21: 199-210
        • Moiemen N.S.
        • Elliot D.
        Primary flexor tendon repair in zone 1.
        J Hand Surg Br. 2000; 25: 78-84
        • Bidwai A.S.C.
        • Feldberg L.
        The button-over-nail technique for zone I flexor tendon injuries.
        Hand Surg. 2012; 17: 365-369
        • Dovan T.T.
        • Gelberman R.H.
        • Kusano N.
        • Calcaterra M.
        • Silva M.J.
        Zone I flexor digitorum profundus repair: an ex vivo biomechanical analysis of tendon to bone repair in cadavera.
        J Hand Surg Am. 2005; 30: 258-266
        • Luenam S.
        • Kosiyatrakul A.
        • Prachaporn S.
        Pullout button suture for the treatment of type IV avulsion of the flexor digitorum profundus tendon: case report.
        J Med Assoc Thai. 2012; 95: S172-S176
        • Evans R.B.
        A study of the Zone I flexor tendon injury and implications for treatment.
        J Hand Ther. 1990; 3: 133-148
        • 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
        • Lee S.K.
        • Fajardo M.
        • Kardashian G.
        • Klein J.
        • Tsai P.
        • Christoforou D.
        Repair of flexor digitorum profundus to distal phalanx: a biomechanical evaluation of four techniques.
        J Hand Surg Am. 2011; 36: 1604-1609
        • Compton J.
        • Wall L.B.
        • Romans S.
        • Goldfarb C.A.
        Outcomes of acute repair versus nonrepair of zone I flexor digitorum profundus tendon injuries.
        J Hand Surg Am. April 9, 2022; (Published online ahead of print, https://doi.org/10.1016/j.jhsa.2022.02.005)
        • 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
        • Schultz R.O.
        • Drake D.B.
        • Morgan R.F.
        A new technique for the treatment of flexor digitorum profundus tendon avulsion.
        Ann Plast Surg. 1999; 42: 46-48
        • 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
        • 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
        • Tuttle H.G.
        • Olvey S.P.
        • Stern P.J.
        Tendon avulsion injuries of the distal phalanx.
        Clin Orthop Relat Res. 2006; 445: 157-168
        • Al-Qattan M.M.
        • Al-Turaiki T.M.
        • Al-Zahrani A.Y.
        • Al-Harbi M.S.
        • Al-Kahtani F.S.
        A new technique of flexor profundus repair in the distal part of zone i: inclusion of the palmar plate.
        J Hand Surg Eur Vol. 2010; 35: 459-463
        • Al-Dubaiban W.I.
        • Al-Abdulkarim A.O.
        • Arafah M.M.
        • Al-Qattan M.M.
        Flexor tendon–to–volar plate repair: an experimental study and 3 case reports.
        J Hand Surg Am. 2014; 39: 2222-2227
        • Al-Qattan M.M.
        Use of the volar plate of the distal interphalangeal joint as a distally based Flap in flexor tendon surgery.
        J Hand Surg Am. 2016; 41: 287-290
        • Haddara M.
        Development of an active finger motion simulator: with in-vitro assessments of tendon loads and joint kinematics.
        Thesis. 2017; (https://ir.lib.uwo.ca/etd/5143/): 34-44
        • Al-Qattan M.M.
        Suturing of the flexor digitorum profundus tendon to the entire volar plate in distal zone I injuries.
        J Plast Surg Hand Surg. 2015; 50: 1-6
        • Kadar A.
        • Haddara M.M.
        • Fan S.
        • Chinchalkar S.
        • Ferreira L.M.
        • Suh N.
        Use of thermoplastic rings following venting of flexor tendon pulleys: a biomechanical analysis.
        J Hand Surg Am. 2021; 46: 485-492
        • Haddara M.M.
        • Byers B.
        • Chinchalkar S.
        • Ferreira L.M.
        • Suh N.
        The effect of wrist position on finger tendon loads following pulley sectioning and operative reconstruction.
        J Hand Surg Glob Online. 2019; 1: 154-160
        • Goislard de Monsabert B.
        • Visser J.M.
        • Vigouroux L.
        • Van der Helm F.C.
        • Veeger H.E.
        Comparison of three local frame definitions for the kinematic analysis of the fingers and the wrist.
        J Biomech. 2014; 47: 2590-2597
        • Coupier J.
        • Moiseev F.
        • Feipel V.
        • Rooze M.
        • Van Sint Jan S.
        Motion representation of the long fingers: a proposal for the definitions of new anatomical frames.
        J Biomech. 2014; 47: 1299-1306
        • Zhao C.
        • Amadio P.C.
        • Berglund L.
        • Zobitz M.E.
        • An K.N.
        A new testing device for measuring gliding resistance and work of flexion in a digit.
        J Biomech. 2003; 36: 295-299
        • Coupier J.
        • Hamoudi S.
        • Telese-Izzi S.
        • Feipel V.
        • Rooze M.
        • Van Sint Jan S.
        A novel method for in-vivo evaluation of finger kinematics including definition of healthy motion patterns.
        Clin Biomech (Bristol, Avon). 2016; 31 (47–38)
        • Degeorges R.
        • Parasie J.
        • Mitton D.
        • Imbert N.
        • Goubier J.N.
        • Lavaste F.
        Three-dimensional rotations of human three-joint fingers: an optoelectronic measurement. Preliminary results.
        Surg Radiol Anat. 2005; 27: 43-50
        • Degeorges R.
        • Laporte S.
        • Pessis E.
        • Mitton D.
        • Goubier J.N.
        • Lavaste F.
        Rotations of three-joint fingers: a radiological study.
        Surg Radiol Anat. 2004; 26: 392-398