A safety technique for Mitek anchor suture rupture: a useful trick

We propose that the simple method of passing an extra suture through the Mitek anchor eyelet before bony insertion provides a safety net against failure of the preloaded suture and gives extra strength to the core repair.     

Spontaneous flexor tendon ruptures of the hand: case series and review of the literature

Spontaneous flexor tendon ruptures within the hand are incompletely understood. We report 5 cases of spontaneous tendon rupture involving the flexor digitorum profundus tendon. One case involves an abnormal intertendinous connection between the ring and small finger profundus tendons and another involves a lumbrical muscle variant. To our knowledge, the latter has not been reported in association with spontaneous tendon rupture. In reviewing the literature for spontaneous flexor tendon ruptures, a total of 50 spontaneous ruptures in 43 cases was found. The majority involve the profundus tendon of the small finger in the palm. The ruptures most often occur during periods of peak strain but can also occur without identifiable trauma. The pathogenesis of spontaneous tendon ruptures is still unclear and is likely multifactorial. Spontaneous flexor tendon ruptures of the hand occur more often than one might recognize.     

Mechanical Properties of the Flexor Digitorum Profundus Tendon Attachment

The current study was performed to determine the strength and rigidity of the intact flexor digitorum profundus (FDP) tendon attachment and compare the rigidity at the attachment site to the rigidity within a more proximal part of the tendon. Eight cadaveric index fingers were tested to failure of the FDP tendon. Lines were drawn on each tendon with India ink stain at the position of the attachment to bone and 5 mm and 10 mm proximally. Each test was recorded using a high resolution video camera. A minimum of six images per test were used for analysis of tissue deformation. The centroid of each line was computationally identified to characterize the deformation of the tendon between the lines. Force vs. deformation curves were generated for the 5 mm region representing the tendon attachment and the 5 mm region adjacent to the attachment. Stiffness measurements were generated for each curve, and normalized by the initial length to determine the rigidity. The failure strength ranged from 263 N to 548 N, with rigidity values ranging from 2201 N/(mm/mm) to 8714 N/(mm/mm) and from 3459 N/(mm/mm) to 6414 N/(mm/mm) for the attachment and the tendon proximal to the attachment, respectively. The rigidity did not vary significantly between the attachment and proximal tendon based on a Wilcoxon signed rank test (p = 0.2). The measured strength and rigidity establish biomechanical properties for the FDP tendon attachment to bone.     

Zone I rupture of the flexor digitorum profundus tendon caused by blunt trauma: a case report

Traumatic ruptures of flexor tendons as a result of blunt trauma without an associated pathologic condition are rare. This is a case of a midsubstance flexor tendon rupture as a result of closed direct trauma. The patient sustained a flexor digitorum profundus (FDP) rupture 1 cm proximal to its insertion on his right ring finger without any accompanying laceration. Additionally, this case highlights the utility of ultrasound in diagnosing ruptured flexor tendon, which has been demonstrated in prior studies.     

Congenital shortening of the flexor digitorum profundus muscle

An 8-year-old boy with a history of the inability to extend the middle finger at the proximal interphalangeal and distal interphalangeal joints with the wrist and metacarpophalangeal joints in the neutral position since the age of 5 months had surgery. The flexor digitorum profundus muscle of the middle finger had a short muscle belly and was replaced in part with mature fat tissue. Histologic examination of the resected tissue showed replacement of a part of the muscle with mature fat tissue. It was speculated that some myosatellite cells, which typically differentiate into skeletal muscle cells, may have erroneously differentiated into adipocytes in the first postnatal year, during which complete development of skeletal muscles occurs.     

Spontaneous flexor tendon rupture of the flexor digitorum profundus secondary to an anatomic variant

We report a case of the flexor digitorum profundus tendon rupture of the little finger, which was predisposed by an anatomic variation of the tendon. Intraoperative findings and magnetic resonance imaging of the opposite hand suggested that the flexor digitorum profundus tendons of the ring and the little finger bifurcated. The patient had tendon reconstruction and regained function. We believe that reconstructing the tendon so that it resembles the normal anatomy prevents the recurrence of tendon rupture.     

Flexor digitorum profundus tendonavulsions

Avulsion of the flexor digitorum profundus (FDP) tendon is a relatively common injury that most frequently involves the ring finger. Misdiagnosis is common but can be avoided with a carefully performed patient interview and examination. Profundus avulsions have been classified into three main types based on the level of tendon retraction, the remaining nutritional supply, the length of time between injury and treatment, and the presence or absence of an associated avulsion fracture. Treatment involves prompt reattachment using a pullout suture technique or open reduction and internal fixation of an appropriate sized avulsion fracture. With careful attention to operative detail, meticulous handling of the tendon, and an early range of motion rehabilitation program, satisfactory outcomes can be expected.     

指深屈肌腱Ⅰ区闭合性断裂的手术治疗

目的 观察并分析手术治疗指深屈肌腱Ⅰ区闭合性断裂的临床效果.方法 2000年1月至2011年12月共收治13例指深屈肌腱Ⅰ区闭合性断裂患者,根据Leddy和Packer分型,Ⅰ型3例、Ⅱ型6例、Ⅲ型3例、Ⅳ型1例,采用了抽出钢丝法、螺钉内固定、克氏针内固定等手术方法进行治疗.结果 术后10例患者获得随访,时间6个月至5年,平均32个月.远指间关节主动活动范围平均48°,其中5例患者伸直-15.～-30°,平均-18°.按Strickland和Glogovac评分标准评定:优2例,良5例,可1例,差2例.结论 早期明确诊断并根据Leddy和Packer分型及时采取相应的手术方法治疗可以取得很好的疗效.     

Hook Plate as a Treatment for Flexor Digitorum Profundus Avulsion Types II and III

Avulsion fracture types II and III of flexor digitorum profundus (FPD), also called Jersey Finger, in flexor zone 1 are an uncommon pathology requiring surgical treatment. The aim of this study was to assess whether hook miniplates were an accessible and reliable option to repair FDP avulsion types II and III. Between July and August 2018, we treated 2 consecutive patients’ zone 1 Leddy-Packer type II and III FDP injuries with hook plates and 1.2 × 7 mm screws included in Medartis Aptus Hand fixation system set. Patients were aged 37 and 39 years, a man and a woman, respectively. At the end of the follow-up, we evaluated the Visual Analog Scale, range of motion, grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand. Both patients completed 12 months of follow-up with excellent functional and radiological results. Neither presented complications or residual disability. This injury has been treated with a wide range of surgical techniques, including anchor suture, pullout button sutures, screws, and plates. However, due to the difficulty in surgical fixation of fragments around finger joints, limited access to ligaments and tendons, and the lack of cases, none of the techniques have turned out as a clear option above others. Hook plates placed in distal phalanx emerge as surgical treatment for FDP avulsion types II and III in flexor zone 1, with excellent clinical outcomes.     

An investigation into the reliability and methodology of the Linburg-Comstock anomaly clinical test

Study DesignThis is a cross-sectional study.IntroductionAn intertendinous connection between the flexor pollicis longus (FPL) and index flexor digitorum profundus (IFDP) tendons causes involuntary index flexion during active thumb flexion and has been named the Linburg-Comstock anomaly (LCA). It may become symptomatic or cause functional limitations. Literature has documented the prevalence to range from 13% to 70%. Cadaver studies have reported an anatomical connection in 5% to 25%.PurposeThis study aimed to examine the methodology and reliability of the LCA clinical diagnostic test and to explore the wide range of reported incidence and the discrepancy between cadaver and subject prevalence.MethodsTwo examiners observed for the presence of involuntary index flexion during 3 separate variations of thumb flexion in 67 subjects (134 limbs); results were considered positive if involuntary flexion occurred at either index interphalangeal joint. Intertester reliability was assessed using Cohen's kappa coefficient. The volar forearm and wrist of 53 cadavers (106 limbs) were dissected and assessed for an observable and mechanical tendinous connection between the FPL and IFDP tendons.ResultsPrevalence for subjects (5%-32%) was at the lower end of the range of previously reported values; results differed with altering thumb flexion motion. Observation for the presence of an intertendinous connection between the FPL and IFDP tendons in cadaver specimens (23%) fell within previously reported ranges. Intertester reliability coefficients ranged from no to weak agreement and varied according to specific thumb flexion motion performed during the test.ConclusionsThe identification of index finger flexion during thumb flexion varied both with thumb flexion motions and with whether flexion was assessed at the index proximal interphalangeal or distal interphalangeal joint. Intertester reliability was low for all variations of the LCA clinical test performed. The wide range in previously reported LCA incidence may be due to variability in testing procedure, and there is a need to establish a reliable and valid clinical test for this potentially symptomatic anatomic anomaly.     

缝合锚钉在修复四肢肌腱止点区断裂伤中的应用

2008年12月～2009年11月,我院采用缝合锚钉修复肌腱、韧带附着点断裂伤14例,取得较好疗效. 1 材料与方法 1.1 病例资料本组14例 男11例,女3例,年龄21～38岁.髌腱断裂4例,膝内侧副韧带损伤3例,跟腱断裂3例,肱三头肌腱断裂2例,喙锁韧带断裂1例,内踝三角韧带1例.受伤至手术时间1～4 d.     

缝合锚钉修复四肢肌腱止点区断裂伤

正2012年1月~2013年4月,我科对19例四肢肌腱止点区断裂伤患者采用缝合锚钉修复,取得较好疗效,报道如下。1材料与方法1.1病例资料本组19例,男15例,女4例,年龄17~39岁。跟腱断裂9例,髌腱断裂5例,膝内侧副韧带损伤1例,肱三头肌腱断裂3例,喙锁韧带断裂1例。受伤后至手术时间1~4 d。1.2治疗方法硬膜外麻醉下手术。     

Suturing of the flexor digitorum profundus tendon to the entire volar plate in distal zone I injuries

Purpose: The author conducted an anatomical and a prospective clinical study to address the technique and complications of using the entire volar plate (VP) as a distally-based flap for distal Zone I flexor digitorum profundus (FDP) tendon repair. Methods: In the anatomical study, eight fresh finger specimens were dissected to study the anatomy of the VP as well as the stability of the distal interphalangeal joint (DIPJ) after raising the entire VP as a distally-based flap. In the clinical series, six patients underwent repair of distal Zone I FDP lacerations using the VP flap technique and were assessed at a mean of 9 months for range of motion as well as DIPJ deformities. Results: The results of the anatomical study showed that the intact collateral ligaments can still maintain the stability of the DIPJ after loss of joint support from the VP. In the clinical series, none of the patients showed joint hyper-extension or flexion contracture at the DIPJ. Using Moiemen-Elliot criteria, the post-operative active range of motion at the DIPJ was rated as excellent in one, good in three, and fair in two patients. Conclusion: It was concluded that the use of the entire VP as a distally based flap is an acceptable technique to repair distal FDP injuries and the technique does not result in DIPJ instability or flexion contracture.