1
|
Haddara MM, Mitchell EC, Gillis JA, Ferreira LM, Suh N. The Evaluation of a Flexor Digitorum Profundus-to-Volar Plate Zone I Repair Versus Button Repair: An In Vitro Biomechanics Study. J Hand Surg Am 2024; 49:706.e1-706.e9. [PMID: 36307286 DOI: 10.1016/j.jhsa.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/07/2022] [Accepted: 09/07/2022] [Indexed: 02/02/2023]
Abstract
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.
Collapse
Affiliation(s)
- Mohammad M Haddara
- 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
| | - Eric C Mitchell
- Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, London, Ontario, Canada; Division of Plastic and Reconstructive Surgery
| | - Joshua A Gillis
- Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, London, Ontario, Canada; Division of Plastic and Reconstructive Surgery
| | - Louis M Ferreira
- 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
| | - Nina Suh
- 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.
| |
Collapse
|
2
|
Al-Qattan MM. My journey in hand surgery: combining patient care, clinical and basic science research. J Hand Surg Eur Vol 2023; 48:710-724. [PMID: 37125458 DOI: 10.1177/17531934231167061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This review is about my clinical and research journey in hand surgery. The journey has been a worthwhile and meaningful one, especially when I felt there were areas I could influence management, whether this be rare cases, common conditions or where a suggested algorithm may be helpful. I also had the unique privilege of working with geneticists, which has resulted in clinical-pathological publications that could influence patient management, as shared from a clinician's perspective. It is hoped this article will inspire young clinician scientists to pursue a journey of collaboration with other researchers.
Collapse
Affiliation(s)
- Mohammad M Al-Qattan
- Division of Plastic and Hand Surgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Fathy Sadek A, Azmy MM, Nady Saleh Elsaid A, Zein AMN, Yehya Hasan M. Repair of flexor digitorum profundus avulsions including the palmar plate: a retrospective comparative study of 56 cases. J Hand Surg Eur Vol 2022; 47:633-638. [PMID: 35107344 DOI: 10.1177/17531934221074514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We retrospectively reviewed 56 fingers with a type 1 flexor digitorum profundus avulsion (jersey finger) injury. Nineteen fingers were treated with a four-strand pull-out suture technique that did not include the distal palmar plate, and 37 were treated with a six-strand pull-out suture technique that included the distal palmar plate. An early active mobilization regimen was used. At follow-up (mean 13 and 14 months, respectively), total active interphalangeal joint motion was significantly better in the six-strand/palmar plate group, as were the results assessed with the Strickland-Glogovac grading system and patient satisfaction according to the Stark criteria. No repair ruptures occurred in this group versus two ruptures in the four-strand/no-palmar-plate group. We consider that the better results can be attributed to a stronger repair, which facilitated early active mobilization.Level of evidence: III.
Collapse
Affiliation(s)
- Ahmed Fathy Sadek
- Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mohamed M Azmy
- Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt
| | | | - Asem M N Zein
- Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mohamed Yehya Hasan
- Orthopaedic Surgery Department, Faculty of Medicine, Minia University, Minia, Egypt
| |
Collapse
|
4
|
Fingertip Winding Suture: Pull-out Suture Technique for Flexor Tendon Repair in Zone I. Tech Hand Up Extrem Surg 2017; 21:143-148. [PMID: 29145347 DOI: 10.1097/bth.0000000000000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Injuries to flexor tendons in zone I has always been challenging during repair. Over the time several techniques were developed and modified to achieve the highest repair strength and thus the best functional outcome. These techniques vary from pull-out sutures with internal and external fixation to the use of bone anchors. All techniques were accompanied with advantages and disadvantages as well as postoperative morbidities related to certain techniques. In the present technique we introduce a subperiosteal pull-out suturing technique. It is a simple, strong, and cost-effective method for repair of flexor tendon injuries in zone I or in the context of tendon grafting.
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW The purposes of this review are to discuss the diagnosis and management of mallet and jersey finger injuries in athletes and to highlight how treatment impacts return to play. RECENT FINDINGS Mallet finger: although numerous non-operative and operative techniques have been described, there continues to be little consensus regarding the optimal procedure. Jersey finger: ultrasound appears to be a cost-effective imaging modality that may be useful for preoperative planning. Wide-awake surgery offers optimal intraoperative assessment of the tendon repair. Tendon repair with volar plate augmentation has been shown to improve the strength of the repair in the laboratory, and early clinical results are encouraging. Most mallet finger injuries will heal with non-operative treatment over a period of 8-12 weeks, even when treatment is delayed up to 3-4 months. An acute diagnosis of jersey finger requires surgical treatment and generally means 8-12 weeks of inability to compete in most contact sports.
Collapse
|
6
|
Use of the Volar Plate of the Distal Interphalangeal Joint as a Distally Based Flap in Flexor Tendon Surgery. J Hand Surg Am 2016; 41:287-90. [PMID: 26684715 DOI: 10.1016/j.jhsa.2015.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 11/07/2015] [Indexed: 02/02/2023]
Abstract
The usual treatment for flexor digitorum profundus (FDP) avulsions as well as FDP lacerations in the distal part of zone I is tendon reinsertion into bone. Although there are several different techniques of FDP tendon reinsertion into bone, they are generally complex and have a weak tensile strength. A technique for treating these injuries is to use the volar plate of the distal interphalangeal joint as a distally based flap for tendon repair. The current communication discusses the technique and its potential complications. Initial clinical experience is encouraging and the volar plate flap technique may take its place in flexor tendon surgery.
Collapse
|
7
|
Al-Qattan MM. Suturing of the flexor digitorum profundus tendon to the entire volar plate in distal zone I injuries. J Plast Surg Hand Surg 2015; 50:119-24. [DOI: 10.3109/2000656x.2015.1111840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
8
|
Brar R, Owen JR, Melikian R, Gaston RG, Wayne JS, Isaacs JE. Reattachment of flexor digitorum profundus avulsion: biomechanical performance of 3 techniques. J Hand Surg Am 2014; 39:2214-9. [PMID: 25227598 DOI: 10.1016/j.jhsa.2014.07.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 07/10/2014] [Accepted: 07/12/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate whether inclusion of the volar plate in repair of flexor digitorum profundus avulsions increases the strength of the repair and resists gapping. METHODS Cadaveric fingers (n = 18) were divided into 3 equal groups. The first technique involved 2 micro-suture anchors only (A). The second used only volar plate repair (VP). The third group was a hybrid, combining a micro-suture anchor with volar plate augmentation (AVP). Specimens were loaded cyclically to simulate passive motion rehabilitation before being loaded to failure. Clinical failure was defined as 3 mm of gapping, and physical failure as the highest load associated with hardware failure, suture breakage, anchor pullout, or volar plate avulsion. RESULTS Gapping throughout cycling was significantly greater for the A group than VP and AVP with no difference detected between VP and AVP groups. Gapping exceeded 3 mm during cycling of 3 A specimens, but in none of the VP or AVP specimens. Load at clinical and physical failure for A was significantly lower than for VP and AVP, whereas no difference was detected between VP and AVP. CONCLUSIONS In this cadaveric model, incorporating the volar plate conferred a significant advantage in strength, increasing the mean load to physical failure by approximately 100 N. CLINICAL RELEVANCE According to previous biomechanical studies, current reconstructive strategies for flexor digitorum profundus zone I avulsions are not strong enough to withstand active motion rehabilitation. We demonstrated the potential use of volar plate augmentation and the prospective advantageous increase in strength in this cadaveric model. In vivo performance and effects on digital motion are not known.
Collapse
Affiliation(s)
- Ravinder Brar
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, Richmond, VA; OrthoCarolina Hand Center, Charlotte, NC
| | - John R Owen
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, Richmond, VA; OrthoCarolina Hand Center, Charlotte, NC
| | - Raymond Melikian
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, Richmond, VA; OrthoCarolina Hand Center, Charlotte, NC
| | - R Glenn Gaston
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, Richmond, VA; OrthoCarolina Hand Center, Charlotte, NC
| | - Jennifer S Wayne
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, Richmond, VA; OrthoCarolina Hand Center, Charlotte, NC
| | - Jonathan E Isaacs
- Orthopaedic Research Laboratory, Departments of Orthopaedic Surgery and Biomedical Engineering, Virginia Commonwealth University, Richmond, VA; OrthoCarolina Hand Center, Charlotte, NC.
| |
Collapse
|
9
|
Flexor tendon-to-volar plate repair: an experimental study and 3 case reports. J Hand Surg Am 2014; 39:2222-7. [PMID: 25282718 DOI: 10.1016/j.jhsa.2014.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/15/2014] [Accepted: 08/16/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the histology and tensile strength of flexor tendon-to-volar plate repair in a sheep model and to evaluate outcomes in 3 clinical cases. METHODS The flexor digitorum profundus (FDP) tendon of the hind limb of the sheep was cut at the ankle. The proximal end of the FDP tendon was then repaired to a distally based flap of the underlying volar plate after 2 cm of the distal FDP tendon were excised such that the distal FDP tendon was not directly in contact with the repair site. The repair was studied histologically and tested biomechanically at 8 intervals (0, 1, 2, 3, 4, 5, 6, 8, and 12 wk) following repair. Three clinical cases with flexor tendon-to-volar plate repair are presented. In all cases, the circumstances of the injury precluded the usual tendon-to-tendon repair. The first patient had a laceration of FDP in zone 1A and the other 2 patients had delayed 2-stage flexor tendon reconstruction. RESULTS The mean breaking strength of the tendon-to-volar plate repair was 26 N at 0 week, 62 N at 1 week, 52 N at 2 weeks, and then progressively increased to reach 312 N at 12 weeks. Histologically, thin randomly arranged collagen fibers were seen at the repair site at 3 weeks; and healing with thick parallel collagen bundles were seen at 6 weeks. Clinically, the flexor tendon-to-volar plate repairs healed without rupture. All patients obtained full active range of motion at the metacarpophalangeal and proximal interphalangeal joints. The active range of motion at the distal interphalangeal joint was 0° to 50° in 2 patients and 0° to 40° in the third patient. CONCLUSIONS The flexor tendon can heal to the volar plate in the sheep model. CLINICAL RELEVANCE Suture of tendon to volar plate is an option in distal zone 1 FDP repair and FDP tendon reconstruction.
Collapse
|
10
|
Forli A, Corcella D, Semere A, Mesquida V, Moutet F. [Management of zone 1 flexor digitorum profundus tendon injuries]. ACTA ACUST UNITED AC 2014; 33 Suppl:S13-27. [PMID: 24837520 DOI: 10.1016/j.main.2014.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/28/2014] [Accepted: 03/06/2014] [Indexed: 11/27/2022]
Abstract
Flexor tendons repair in zone 1 is classically considered providing good results with an overall satisfactory finger function. However, the objective functional results after surgical repair of flexor digitorum profundus are sometimes disappointing. The authors describe the different surgical repair techniques available to the operator from so-called "traditional" sutures to newer methods of internal fixation using miniaturized anchor sutures. The management of postoperative procedures, that of failures and old cases are reported.
Collapse
Affiliation(s)
- A Forli
- Clinique de chirurgie de la main et des brûlés, hôpital Albert-Michallon, CHU de Grenoble, 38243 Grenoble cedex 9, France.
| | - D Corcella
- Clinique de chirurgie de la main et des brûlés, hôpital Albert-Michallon, CHU de Grenoble, 38243 Grenoble cedex 9, France
| | - A Semere
- Clinique de chirurgie de la main et des brûlés, hôpital Albert-Michallon, CHU de Grenoble, 38243 Grenoble cedex 9, France
| | - V Mesquida
- Clinique de chirurgie de la main et des brûlés, hôpital Albert-Michallon, CHU de Grenoble, 38243 Grenoble cedex 9, France
| | - F Moutet
- Clinique de chirurgie de la main et des brûlés, hôpital Albert-Michallon, CHU de Grenoble, 38243 Grenoble cedex 9, France
| |
Collapse
|
11
|
Abstract
This review aims to highlight the differences in the management of flexor tendon injuries between children and adults. These include differences in epidemiology, anatomy, classification, diagnosis, incisions and skin closure, the size of the flexor tendons, technical aspects of zones I and II repairs, core suture purchase length, rehabilitation, results, and complications of primary flexor tendon repair. Finally, one- versus two-stage flexor tendon reconstruction in children is reviewed.
Collapse
Affiliation(s)
- M M Al-Qattan
- Division of Plastic and Hand Surgery, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
12
|
Zone I Flexor Profundus Tendon Repair in Children 5–10 Years of Age Using 3 “Figure of Eight” Sutures Followed by Immediate Active Mobilization. Ann Plast Surg 2012; 68:29-32. [DOI: 10.1097/sap.0b013e31820e0e19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|