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Mousa S, Shirley R. Unusual twisting of a reconstructed FDP tendon of the little finger after spontaneous attrition rupture on the hamate bone: a case report. J Surg Case Rep 2022; 2022:rjac539. [DOI: 10.1093/jscr/rjac539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/03/2022] [Indexed: 11/28/2022] Open
Abstract
Abstract
We describe a case of attrition rupture of flexor digitorum profundus tendon of the right little finger in a 64-year-old lady caused by a prominent hook of hamate. The tendon was reconstructed primarily by palmaris longus tendon graft and was complicated by tendon graft twisting by scar tissue, resulting in the inability to fully extend the finger.
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Affiliation(s)
- Samar Mousa
- Plastic , Reconstructive and Hand Surgery, , Aylesbury , UK
- Buckinghamshire Healthcare NHS Trust , Reconstructive and Hand Surgery, , Aylesbury , UK
| | - Rebecca Shirley
- Plastic , Reconstructive and Hand Surgery, , Aylesbury , UK
- Buckinghamshire Healthcare NHS Trust , Reconstructive and Hand Surgery, , Aylesbury , UK
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Lee JS, McGrouther DA. Are Flexor Tendon Ruptures Ever Spontaneous? - A Literature Review on Closed Flexor Tendon Ruptures of the Little Finger. J Hand Surg Asian Pac Vol 2019; 24:180-188. [DOI: 10.1142/s2424835519500243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: When closed ruptures of flexor tendons of fingers occur, there is often an identifiable pathology, which should be addressed in the same surgical setting as the tendon repair. The concept of “spontaneous” tendon rupture, occurring in the absence of identified pathology, however, has also been reported in a significant number of papers. This controversy has prompted us to do a review of the existing literature.Methods: We did a review of cases of closed ruptures of the flexor digitorum profundus (FDP) of the little finger in existing literature. Fifty-three publications were retrieved by searching “FDP tendon rupture” and “little finger” using PubMed database. We analyzed data such as the zone of rupture noted intra-operatively; and any precipitating factors, pathology or trauma. We also conducted a review on papers which discussed the concept of “spontaneous rupture”.Results: Fifty-three publications were retrieved. There were 8 cases of ruptures in Zone I; 2 in Zone II; 30 in Zone III; 59 in Zone IV and 5 in Zone V. Majority of cases were associated with an element of trauma of varying severity, or pathology. A precipitating cause was not documented in 12 cases. Amongst all 36 cases of ruptures labelled as “spontaneous”, only 1 case was truly “spontaneous” without any associated trauma or pathology.Conclusions: Most reports labeled as spontaneous rupture occurred in Zone III, where tendon ruptures are rare. There are documented pathological causes or evidence of trauma to most of these cases. We conclude these ruptures may have been mislabeled as spontaneous ruptures. Bearing in mind the propensity for tendon excursion, we suspect the lack of documentation of exploration in proximal zones contributed to this mislabeling. Understanding this concept of non-spontaneity to most tendon ruptures and the common sites of rupture or pathology is crucial for a surgeon to make strategic incisions and minimize future recurrence.
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