1
|
Salas C, McIver ND, Telis A, Tufaro R, Qeadan F, Gross J, Mercer D. A Biomechanical Analysis of the H-Taping Method Used by Rock Climbers as Prophylactic or Stabilizing Fixation of Partial A2 Pulley Tears. J Hand Surg Am 2023; 48:1272.e1-1272.e8. [PMID: 35870957 DOI: 10.1016/j.jhsa.2022.05.002] [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: 04/10/2021] [Revised: 03/26/2022] [Accepted: 05/11/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Rock climbing can lead to upper-extremity injuries, such as A2 pulley ruptures, leading to the bowstringing of the flexor tendons. Climbing finger positions are specific and can put undue stress on the pulley systems. This causes severe hand dysfunction and is a difficult problem to treat, and prevention is important. Using a cadaveric, experimental model, we evaluated the effectiveness of the H-taping method, commonly used by rock climbers, to prevent and treat A2 pulley tears. METHODS Using fourteen matched pairs of fresh-frozen cadaveric hands with forearms, four experiments were conducted with 56 paired comparisons evaluating the failure force, fingertip force, and mode of failure (112 total tests). Comparisons were as follows: index fingers- intact versus 50% distal A2 pulley tears without H-taping (control); ring fingers- intact versus H-taping as a prophylactic for A2 pulley tears; little fingers- 50% distal A2 pulley tears with H-tape versus without tape; and middle fingers- H-taping as a prophylactic versus H-taping as a stabilizing treatment of torn pulleys. RESULTS The mean index finger failure force was significantly higher in intact vs torn A2 pulleys (control). Failure force for intact H-taped fingers was significantly higher than torn H-taped fingers, but no other finger comparisons for failure force were significant. There were no significant findings in comparison of mean fingertip force values in any of the experiments. CONCLUSIONS We found that H-taping is not effective as prophylaxis against A2 pulley ruptures or as a stabilizing treatment method for partially ruptured pulleys. CLINICAL RELEVANCE While H-taping has not been recommended as prophylaxis for preventing A2 pulley ruptures, the climbing community has embraced this technique as a preventative measure. The present study provides biomechanical evidence against H-taping for this purpose. Furthermore, it does not appear to aid in increasing fingertip force after injury.
Collapse
Affiliation(s)
- Christina Salas
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, NM; Department of Chemical & Biological Engineering, The University of New Mexico School of Engineering, Albuquerque, NM.
| | - Natalia D McIver
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, NM; Department of Chemical & Biological Engineering, The University of New Mexico School of Engineering, Albuquerque, NM
| | - Alexander Telis
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Rachel Tufaro
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, NM; Department of Chemical & Biological Engineering, The University of New Mexico School of Engineering, Albuquerque, NM
| | - Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola University, Chicago, IL
| | - Jessica Gross
- Biostatistics, Epidemiology, and Research Design, Clinical & Translational Science Center, The University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Deana Mercer
- Department of Orthopaedics & Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, NM
| |
Collapse
|
2
|
Artiaco S, Bosco F, Lusso A, Cioffi LL, Battiston B, Massè A. Flexor Tendon Pulley Injuries: A Systematic Review of the Literature and Current Treatment Options. J Hand Microsurg 2023; 15:247-252. [PMID: 37701320 PMCID: PMC10495204 DOI: 10.1055/s-0042-1749420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Closed injuries of the finger flexor pulley system are rare among the general population, and most of them occur during rock climbing. During the last few decades, scientific interest on this topic has increased. We conducted a systematic review of the literature according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The research was limited from January 2000 to March 2022. PubMed and Scopus databases were investigated for full-text articles published in English, French, and Italian using the following MeSH terms: ([pulley rupture] OR [finger pulley lesion]) AND ([injur*] OR [ruptur*] OR [damage] OR [trauma*]). Initial screening results identified 461 studies, among which 172 were included after including additional records identified through other sources and excluding repeated studies. Finally, four clinical studies were included in the analysis. The methodological quality of the articles was evaluated through the methodological index for nonrandomized studies (MINORS) score. Our search identified four studies that enrolled a total of 189 patients, of whom 164 were male and 25 were female. We finally examined 154 patients with a total of 208 pulleys damaged. Except for the thumb, all fingers were involved. Depending on the type of flexor pulley injury, graded with Schöffl classification, 69 patients underwent a surgical procedure, whereas 85 patients were treated conservatively. Closed finger pulleys injury occurred in rock climbers and non - rock climbers. All patients had excellent results on the Buck-Gramcko score regardless of the return to sports activity. Considering the overall outcomes of the reviewed articles, functional results were satisfactory in both conservative and surgical treatment. Moreover, in grade 3 and 4, surgical results were positive regardless of the specific technique used for finger pulley reconstruction. Only minor complications were reported. Closed flexor tendon pulley injuries require a careful clinical and imaging examination to confirm the diagnosis. In most cases, positive clinical results can be achieved with either conservative or surgical therapy.
Collapse
Affiliation(s)
- Stefano Artiaco
- Department of Orthopaedics and Traumatology, University of Torino, CTO Torino, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Torino, CTO Torino, Italy
| | - Alessandro Lusso
- Department of Orthopaedics and Traumatology, University of Torino, CTO Torino, Italy
| | - Luigi Luca Cioffi
- Department of Orthopaedics and Traumatology, CTO Napoli, Napoli, Italy
| | - Bruno Battiston
- Department of Orthopaedics and Traumatology, University of Torino, CTO Torino, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Torino, CTO Torino, Italy
| |
Collapse
|
3
|
Bosco F, Giustra F, Lusso A, Faccenda C, Artiaco S, Massè A. Closed flexor pulley injuries: A literature review and current practice. J Orthop 2022; 34:246-249. [PMID: 36131797 PMCID: PMC9483560 DOI: 10.1016/j.jor.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 11/22/2022] Open
Abstract
Background Closed flexor pulley injuries are a clinical entity of great interest in hand surgery, and these lesions could be observed mainly in rock-climbing athletes. Objective An extensive literature search of PubMed, SCOPUS, Cochrane Library, and Web of Sciences databases on closed finger pulley rupture, related treatments, and outcomes were performed. All relevant information was used in this literature review. Conclusions Many athletes are potentially exposed to these uncommon injuries. Therefore, these lesions require careful examination and a high index of suspicion to confirm the diagnosis and identify the degree of soft tissue injury, particularly in patients not involved in sporting activities. The data summarized in this literature review demonstrated that according to Schöffl's classification, conservative treatment should be indicated for low-grade injuries (grade 1 or 2), whereas surgical treatment should be performed in patients with more severe acute injuries (grade 4). Grade 3 flexor pulley injuries lie in a grey area where conservative and surgical treatment may give good clinical and return-to-sport patient results.
Collapse
Affiliation(s)
- Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Turin, Italy
| | - Alessandro Lusso
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Turin, Italy
| | - Carlotta Faccenda
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Turin, Italy
| | - Stefano Artiaco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Turin, Italy
| |
Collapse
|
4
|
Primarily conservative treatment for triple (A2-A3-A4) finger flexor tendon pulley disruption. HAND SURGERY & REHABILITATION 2021; 40:314-318. [DOI: 10.1016/j.hansur.2020.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 01/03/2023]
|
5
|
Altman PR, Fisher MWA, Goyal KS. Zone 2 Flexor Tendon Repair Location and Risk of Catching on the A2 Pulley. J Hand Surg Am 2020; 45:775.e1-775.e7. [PMID: 32408998 DOI: 10.1016/j.jhsa.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 11/20/2019] [Accepted: 01/10/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the region of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons in zone 2 that, when involved by a laceration repair, will reliably catch on the A2 pulley after surgery. METHODS Using fresh-frozen cadavers (5 hands, 20 digits), excursions of the FDP and FDS tendons were measured in relation to the A2 pulley. The C1, A3, and C2 pulleys were resected. The digit was maximally flexed by applying traction to the flexor tendon in the forearm. An 8-0 suture tag was placed in the flexor tendons immediately distal to the A2 pulley. The digit was then passively fully extended to measure tendon excursion. Measurements were repeated with 50% venting and 100% release of the A4 pulley. Reference points such as tendon insertions and flexion creases were obtained. This protocol was repeated sequentially for the index, middle, ring, and little fingers. RESULTS For all 20 fingers, the suture placed into the FDP just distal to the A2 pulley with the finger fully flexed traveled 1.6 ± 1.9 mm distal to the proximal edge of the A4 pulley with passive extension of the finger. The mean excursion for the FDP was 24.6 ± 3.2 mm, and 16.9 ± 3.1 mm for the FDS. The mean A2 pulley length was 16.2 ± 3.5 mm, and the mean distance between the distal edge of the A2 pulley and the proximal edge of the A4 pulley was 23.0 ± 3.3 mm. Venting the A4 pulley 50% and 100% increased FDP excursion a maximum of 0.9 and 1.9 mm, respectively. CONCLUSIONS An FDP repair proximal to the A4 pulley will slide under the A2 pulley with full active digital flexion after surgery. If the distal FDP stump lies underneath the A4 pulley with the digit fully extended, the FDP repair will not likely engage the A2 pulley with full flexion after surgery. The FDP excursion can be reliably predicted as a percentage of the A2 (distal) to the A4 (distal) pulley distance. Most importantly, the distance between the repair site and the A4 pulley approximately equals the length of the A2 pulley that requires release to avoid postoperative triggering. CLINICAL RELEVANCE Knowledge of this high-risk region of flexor tendon repair will guide surgeons regarding the potential need for partial release of the A2 pulley.
Collapse
Affiliation(s)
- Perry R Altman
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Miles W A Fisher
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kanu S Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
| |
Collapse
|
6
|
Abstract
Increasing numbers of people are participating in the sport of rock climbing, and its growth is expected to continue with the sport's Olympic debut in 2020. Extreme loading of the upper extremities, contorted positioning of the lower extremities, rockfall, and falling from height create an elevated and diverse injury potential that is affected by experience level and quantity of participation. Injuries vary from acute traumatic injuries to chronic overuse injuries. Unique sport-specific injuries to the flexor tendon pulley system exist, but the remaining musculoskeletal system is not exempt from injury. Orthopaedic evaluation and surgery is frequently required. Understanding the sport of rock climbing and its injury patterns, treatments, and prevention is necessary to diagnose, manage, and counsel the rock-climbing athlete.
Collapse
|
7
|
Algar L, Moschetto M. Pulley injuries in rock climbers: Hand therapy clinical application. J Hand Ther 2019; 31:416-420. [PMID: 29042159 DOI: 10.1016/j.jht.2017.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/25/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Lori Algar
- Department of Hand Therapy, Orthopaedic Specialty Group, P.C., Fairfield, CT, USA.
| | - Matthew Moschetto
- Department of Occupational Therapy, Sacred Heart University, Fairfield, CT, USA
| |
Collapse
|
8
|
Schellhammer F, Vantorre A. Semi-dynamic MRI of climbing-associated injuries of the finger. Skeletal Radiol 2019; 48:1435-1437. [PMID: 31037344 DOI: 10.1007/s00256-019-03216-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/11/2019] [Accepted: 04/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Injuries of the flexor-tendon-pulley system are common in rock climbers. The status of the A3 pulley ligament is crucial for grading such injuries. As standard MRI may miss lesions of the A3 pulley ligament, we introduce a semi-dynamic MRI sequence. MATERIALS AND METHODS Twenty-two fingers (14 volunteers, 3 injured climbers) were scanned using a sagittal T1 turbo spin echo sequence (repetition time: 400 ms, echo time: 14 ms, slice thickness: 5 mm) in six consecutive finger positions from stretched to maximum possible flexion. RESULTS No pulley lesion was found in volunteers. Bowstringing was detected in 3 injured fingers including the A3 pulley. CONCLUSION Semi-dynamic MRI is an technique that is easy to perform to identify injuries of the A3 pulley ligament that were not seen on standard imaging.
Collapse
Affiliation(s)
- Frank Schellhammer
- Diagnostic and Interventional Radiology, Krankenhaus der Augustinerinnen Köln, Jakobstrasse 27-31, 50678, Cologne, Germany.
| | - Andreas Vantorre
- Network of Sports Medicine in Rock Climbing, Dietrichstrasse 18, 60439, Frankfurt, Germany
| |
Collapse
|
9
|
Lum ZC, Park L. Rock climbing injuries and time to return to sport in the recreational climber. J Orthop 2019; 16:361-363. [PMID: 31024194 DOI: 10.1016/j.jor.2019.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 04/03/2019] [Indexed: 01/03/2023] Open
Abstract
We investigated the injury pattern in rock climbers and their return to sport for operative and nonoperative management. 432 injuries in 237 climbers recorded: 41.9% hand/elbow, 19.9% foot/ankle, 17.3% shoulder. 66% patients required no treatment, 49 (21%) underwent physical therapy, 27 (11%) underwent surgery with 93% satisfaction. Nonoperative patients recovered at 3.9 months; surgical patients took 9.1 months to return to sport (p = 0.01). Return to same level: 79% nonsurgical patients and 70% surgical patients (p = 0.30). Most injuries underwent nonoperative treatment. Operative treatment allowed a similar amount to return to sport at pre-injury level with a longer time course.
Collapse
Affiliation(s)
- Zachary C Lum
- University of California: Davis Medical Center, Department of Orthopaedic Surgery, Adult Hip & Knee Reconstruction, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA
| | - Lily Park
- Memorial Medical Center, Department of Internal Medicine, Modesto, CA, 95350, USA
| |
Collapse
|
10
|
Kachouh N, Cerlier A, Bouyer M, Legré R. Result of A1 pulley reconstruction after closed rupture of the thumb pulleys during childbirth. HAND SURGERY & REHABILITATION 2018; 37:311-315. [PMID: 30026019 DOI: 10.1016/j.hansur.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 11/27/2022]
Abstract
Closed rupture of the thumb flexor tendon pulleys is rare. Although anatomical and biomechanical studies have exposed the roles played by the pulleys in flexor pollicis longus (FPL) function, no standardized surgical management has yet been defined, in contrast to situations where pulley reconstruction is required in the fingers. We describe a case of rupture of the three pulleys in the thumb that probably occurred after violent thumb grasp during childbirth in the absence of any other trauma. We reconstructed the A1 pulley only using an extensor retinaculum graft because no remnants of the native pulleys were present.
Collapse
Affiliation(s)
- N Kachouh
- Department of hand and reconstructive surgery, hôpital de la Timone, chirurgie de la main et réparatrice des membres, Aix-Marseille University, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
| | - A Cerlier
- Department of hand and reconstructive surgery, hôpital de la Timone, chirurgie de la main et réparatrice des membres, Aix-Marseille University, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
| | - M Bouyer
- Service de chirurgie de la main et des brûlés, centre hospitalier universitaire de Grenoble, boulevard de la Chantourne, 3870, La Tronche, CS 10217, 38043 Grenoble, France.
| | - R Legré
- Department of hand and reconstructive surgery, hôpital de la Timone, chirurgie de la main et réparatrice des membres, Aix-Marseille University, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
| |
Collapse
|
11
|
Acute A4 Pulley Reconstruction with a First Extensor Compartment Onlay Graft. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1361. [PMID: 28740775 PMCID: PMC5505836 DOI: 10.1097/gox.0000000000001361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/17/2017] [Indexed: 11/26/2022]
Abstract
Background: The integrity of the flexor tendon pulley apparatus is crucial for unimpaired function of the digits. Although secondary reconstruction is an established procedure in multi-pulley injuries, acute reconstruction of isolated, closed pulley ruptures is a rare occurrence. There are 3 factors influencing the functional outcome of a reconstruction: gapping distance between tendon and bone (E-space), bulkiness of the reconstruction, and stability. As direct repair is rarely done, grafts are used to reinforce the pulley. An advantage of the first extensor retinaculum graft is the synovial coating providing the possibility to be used both as a direct graft with synovial coating or as an onlay graft after removal of the synovia when the native synovial layer is present. Methods: A graft from the first dorsal extensor compartment is used as an onlay graft to reinforce the sutured A4 pulley. This technique allows reconstruction of the original dimensions of the pulley system while stability is ensured by anchoring the onlay graft to the bony insertions of the pulley. Results: Anatomical reconstruction can be achieved with this method. The measured E-space remained 0 mm throughout the recovery, while the graft incorporated as a slim reinforcement of the pulley, displaying no bulkiness. Conclusions: The ideal reconstruction should provide synovial coating and sufficient strength with minimal bulk. Early reconstruction using an onlay graft offers these options. The native synovial lining is preserved and the graft is used to reinforce the pulley.
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW While hand injuries occur frequently in the athletic population, sagittal band ruptures, boutonniere deformities, and pulley ruptures are infrequently encountered. These injuries represent diagnostic challenges and can result in significant impairment. Early recognition with appropriate treatment is necessary to maximize recovery and minimize return to athletic competition. This review will focus on the underlying mechanism, pathophysiology of injury, diagnosis, and treatment of each of these injuries. RECENT FINDINGS With respect to sagittal band ruptures, boutonniere deformities, and pulley ruptures, the recent literature has been limited in scope. For sagittal band injuries, current efforts have focused on alternative techniques for sagittal band reconstruction. Little progress has been made in recent years with respect to boutonniere injuries in the athletic population; prevention of fixed deformities remains the backbone of treatment. The exact contribution from individual and combined pulley injuries in the creation of bowstringing remains controversial. Recent anatomical studies have failed to definitively answer the question of what degree of rupture is necessary to create symptomatic bowstringing. Favorable outcomes, with respect to both preventing bowstringing and returning to full athletic participation, have been newly reported following pulley reconstruction in rock climbers. Due to the infrequent nature of sagittal band ruptures, boutonniere deformities, and pulley ruptures, current treatment is mostly guided by historically established methods, limited case series, and case reports. Nonsurgical treatment remains the mainstay for most injuries and, if employed early, often precludes the need for surgery. Further anatomical and clinical research, including outcome studies, is necessary in guiding treatment algorithms.
Collapse
Affiliation(s)
- Louis Christopher Grandizio
- Division of Hand and Microsurgery, Department of Orthopaedics (52-12), Geisinger Medical Center, 115 Woodbine Lane, Danville, PA, 17820, USA.
| | - Joel Christian Klena
- Division of Hand and Microsurgery, Department of Orthopaedics (52-12), Geisinger Medical Center, 115 Woodbine Lane, Danville, PA, 17820, USA
| |
Collapse
|
13
|
Abstract
Closed pulley ruptures are rare in the general population but occur more frequently in rock climbers due to biomechanical demands on the hand. Injuries present with pain and swelling over the affected pulley, and patients may feel or hear a pop at the time of injury. Sequential pulley ruptures are required for clinical bowstringing of the flexor tendons. Ultrasound confirms diagnosis of pulley rupture and evaluates degree of displacement of the flexor tendons. Isolated pulley ruptures frequently are treated conservatively with early functional rehabilitation. Sequential pulley ruptures require surgical reconstruction. Most climbers are able to return to their previous activity level.
Collapse
Affiliation(s)
- Elizabeth A King
- Department of Orthopaedic Surgery, University of Cincinnati, TriHealth Hospital System, 538 Oak Street, Suite 200, Cincinnati, OH 45219, USA
| | - John R Lien
- Section of Plastic Surgery, Department of Orthopaedic Surgery, University of Michigan, 2098 South Main Street, Ann Arbor, MI 48103, USA.
| |
Collapse
|
14
|
Moriya K, Yoshizu T, Tsubokawa N, Narisawa H, Hara K, Maki Y. Clinical results of releasing the entire A2 pulley after flexor tendon repair in zone 2C. J Hand Surg Eur Vol 2016; 41:822-8. [PMID: 27178574 DOI: 10.1177/1753193416646521] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 03/23/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED We report the results of complete release of the entire A2 pulley after zone 2C flexor tendon repair followed by early postoperative active mobilization in seven fingers and their comparisons with 33 fingers with partial A2 pulley release. In seven fingers, release of the entire A2 pulley was necessary to allow free gliding of the repairs in five fingers and complete release of both the A2 and C1 pulleys was necessary in two. No bowstringing was clinically evident in any finger. Two fingers required tenolysis. Using Tang's criteria, the function of two digits was ranked as excellent, four good and one fair; there was no failure. The functional return in these seven fingers was similar with that in 33 fingers with partial A2 pulley release; in these patients only one finger required tenolysis. Our results support the suggestion that release of the entire A2 pulley together with the adjacent C1 pulley does not clinically affect finger motion or cause tendon bowstringing, provided that the other pulleys are left intact. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- K Moriya
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - T Yoshizu
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - N Tsubokawa
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - H Narisawa
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - K Hara
- Niigata Hand Surgery Foundation, Niigata, Japan
| | - Y Maki
- Niigata Hand Surgery Foundation, Niigata, Japan
| |
Collapse
|