[Comparison between different anchors for zone I flexor tendon repair]. / Comparaison des différentes ancres dans les réinsertions transosseuses de tendons fléchisseurs profonds en zone I.

INTRODUCTION: Transosseous reinsertion has been used to complement the Bunnell pull-out technique in the repair of zone I deep flexor tendon injuries. The aim of this study is to compare the different devices on the market in terms of complication, functional recovery and ease of use. MATERIAL AND METHOD: This is a single-center study including all patients who underwent transosseous anchor reinsertion from 2010 to 2021 with a minimum of 6 months of follow-up. Twenty-seven patients were included. The anchors used were of different types: Microfix® Quickanchor plus® and Miniquick anchor® from DePuy Mitek; Juggerknot® Soft Anchor 1.0mm from Zimmer-Biomet; or Kerifix® 4.0 from KeriMedical. We analyzed intraoperative data, complications and functional recovery by quickDASH score. RESULTS: The average age was 38.6 years (± 16.1), the demographic characteristics were identical in the different groups. There was a significant difference in the number of anchors used intraoperatively before definitive placement (P=0.02), to the disadvantage of the Juggerknot® anchors. There was no significant difference in terms of complications and functional recovery evaluated by the quickDASH. CONCLUSION: Our study did not find significant differences between the different anchors in terms of complications and functional recovery. Some anchors seem to have a better grip during placement than others.

Enlargement of the flexor pulleys by an omega plasty: A study comparing the release of one or both sides of the A2 and/or A4 pulley.

PURPOSE: The omega plasty on one side of the A2 and/or A4 pulley improves the gliding of repaired flexor tendons in zone II. The purpose of this study was whether or not the enlargement of the digital channel was better after the release of one or both sides of each pulley. METHODS: In fresh cadavers, the technique was to first disinsert the ulnar attachments of the A2 and A4 pulleys and then the radial insertions. An ultrasound was used to measure the large axis, the circumference, and the cross-sectional surface of each of A2 and A4 pulleys before release, after ulnar release and after radial release. RESULTS: The release of the A2 pulley reduces the risk of conflict in the sutured flexor tendons in the digital channel. The release of the A4 pulley seems less effective than that of A2. The release of the two pulleys reduces the risk of conflict in one sutured zone of the flexor tendons in the digital channel. CONCLUSION: In all, if there is a conflict between the flexor tendons sutured opposite A2, we recommend an omega plasty on the two sides of the pulley. If the conflict appears opposite A4, we recommend the plasty of the two sides of A4 and A2.

Jersey finger type IV: a case report.

Avulsion of the flexor digitorum profundus, usually known as jersey or rugby finger, is a rare condition that can only be treated surgically. It is mostly reported in sports injuries, in which the diagnosis is easily made. It is less frequent in household accidents, but should not be ignored because good results are time-dependent. Type IV jersey finger is the combination a fracture of the volar base of the distal phalanx and avulsion of the flexor digitorum profundus. This is a rare variety, and the surgical approach has not been discussed in detail. We introduce here a case report describing the clinical aspect, diagnostic approach, surgical technique and results at 6 months.

Proximal row carpectomy combined with primary flexor pollicis longus tenorrhaphy: An effective treatment alternative for a rare case of flexor pollicis longus rupture due to scaphoid nonunion advanced collapse.

This study describes a case of flexor pollicis longus rupture resulting from long-term scaphoid nonunion advanced collapse. The tendon rupture mechanism was attrition due to sharp bone protuberances from the scaphoid in the carpal tunnel. Although this extremely rare complication has already been reported in the literature, our study is original in showing that proximal row carpectomy with consequent wrist shortening allowed primary tendon repair without transferring the flexor digitorum superficialis tendon of the ring finger or grafting the palmaris longus tendon, which besides using two-level suturing, interposes a non-vascularized tissue.

Splints, with or without wrist immobilization, following surgical repair of flexor tendon lesions of the hand: A systematic review.

Splints with or without wrist immobilization can be used during the rehabilitation of flexor tendon lesions of the hand. The evidence base for these techniques has not previously been studied in a systematic review. We sought to thoroughly review patient-reported functional outcomes and pain to compare splinting with or without wrist immobilization. Five bibliographic databases were searched. Studies were considered for inclusion if they were randomized controlled trials or observational comparative studies reporting the difference in outcome among patients treated with or without wrist immobilization. No limits were set on publication date or language. Study selection was performed independently by two authors, and disagreements were resolved by consensus. The review protocol was preregistered in PROSPERO. There were no randomized controlled trials. No studies could be included based on our inclusion criteria. We decided to qualitatively summarize the most relevant studies although they did not meet our inclusion criteria. This resulted in a narrative review of the studies we found relevant. Based on the current literature, it is impossible to provide evidence-based recommendations for or against wrist immobilization during the rehabilitation period following flexor tendon repair. The lack of high-quality evidence points to a need for randomized clinical trials to guide rehabilitation decisions.

Efficacy of corticosteroid injection in rock climber's tenosynovitis.

While many finger conditions in climbers have been studied extensively, no data exist on the treatment of rock climber's finger flexor tenosynovitis. The purpose of this study was to evaluate the outcomes after corticosteroid injection. The study included rock climbing athletes suffering from chronic (longer than 6 weeks) finger flexor tenosynovitis who were seen at our clinic in 2017. All 42 patients received two corticosteroid injections within a 7-10 day period. Thirty-one climbers (73.8%) were pain free after the second injection and a mean of 20.9±23.1 days. The climbers reported an 84.2% decrease in pain level and no complications. The positive outcome after corticosteroid injection therapy and the absence of complications justifies this invasive approach in rock climbing athletes.

Closed disruption of a single flexor digitorum superficialis tendon slip: 3 cases.

Two men and one woman (age 31, 36 and 45 years) felt a painful pop in the left middle, right middle and right index finger during sport-related activities (2 sport climbing and 1 judo). Clinical examination found a painful flexor tendon in zone 2 but no function deficit specific to the flexor digitorum superficialis (FDS) tendon. MRI and ultrasonography revealed a complete disruption of the radial FDS tendon slip only, which was found retracted between the A2 and A3 pulleys. All flexor tendon pulleys remained intact. Conservative and functional treatment resulted in unrestricted normal function and return to sport. Disruption of one FDS tendon slip is a differential diagnosis for a popping incident in the finger, which is typically associated with a closed flexor tendon pulley injury.

Comparison of the strength of two multi-strand tendon repair configurations in a chicken model.

We sought to investigate the strength of two multi-strand tendon repair configurations in a chicken model. Fifty-six chicken flexor tendons were repaired with one to two different four-strand configurations: 1) a four-strand repair consisting of a two-strand core modified Kessler suture with a circle loop repair and 2) a four-strand core Kessler suture repair with three separate peripheral suture points. The strength of the repaired tendons were measured 2, 3 and 4 weeks after the surgical repair and were analyzed statistically. The strength of the two repair methods was not statistically different 2 weeks after surgery. The tendons repaired with the four-strand core Kessler suture repair and three separate peripheral suture points were significantly stronger than those repaired with a two-strand core modified Kessler suture and a circle loop repair at 3 weeks (P = 0.033) and 4 weeks (P = 0.039). The four-strand repair with three separate peripheral suture points had greater strength than a two-strand repair with one circle loop suture based on an in vivo chicken flexor tendon model.

Biomechanical study comparing Pulvertaft suture to step-cut suture.

Tendon grafts are a component of the therapeutic arsenal for managing chronic flexor tendons injuries in the hand, especially during two-stage Hunter reconstruction. The purpose of this anatomical study was to compare the strength of the Pulvertaft weave versus the step-cut suture used for flexor tendon reconstruction to determine their role in early active mobilization. We performed a biomechanical study with cadaver specimens. Thirty-four hands were randomized and the tendons from both hands were equally assigned to each group. A comparison of the Pulvertaft weave (group 1) versus the step-cut suture (group 2) using the flexor digitorum profundus from the fourth finger and the longus palmaris was carried out. The main variable was the failure load in both repair groups. We also evaluated the cross-sectional area (CSA) and the tensile strength of the repairs. Thirty hands were included in our study. There was no significant difference in the failure load between the two groups (116N for group 1 versus 103N for group 2, P=0.2). The CSA was significantly smaller in the step-cut group compared to Pulvertaft group (19.8mm2 versus 35mm2, P<0.01). The tensile strength was significantly higher in the step-cut group than in the Pulvertaft group (5.3N/mm2 versus 3.4N/mm2, P<0.01). Early active mobilization requires a minimum repair strength of 75N. In our study, the step-cut suture appears strong enough and thin enough to decrease the fibrosis, which would lead to better functional results. No other study of this type has been published. The specimens in which the repair strength was less than 75N all involved a thin, weak longus palmaris. Other biomechanical studies should be done to define the anatomical criteria required for use of the palmaris longus tendon. The step-cut suture seems to be strong enough and thin enough to provide sufficient proximal attachment during flexor tendon reconstruction to allow early active mobilization.

Ultrasonographic evaluation of the distance between the flexor pollicis longus tendon and volar prominence of the plate as a function of volar plate positioning and pronator quadratus repair - A cadaver study.

Flexor tendon injury after volar plating of distal radius fractures is due to friction against the plate. To assess this risk, the distance between the flexor pollicis longus (FPL) and the volar prominence of the plate was measured with ultrasonography under various conditions: a standard plate fixed proximal or distal to the watershed line and a low-profile volar rim plate, with and without transection of the pronator quadratus (PQ). Distance from the FPL to the volar prominence of the plate decreased significantly when the PQ was cut and when a standard plate was placed distal to the watershed line, with the tendon often bulging over the plate. No statistical difference was measured between a volar rim plate and a standard plate distal to the watershed line. Our results confirm the importance of positioning the volar plate proximal to the watershed line and of repairing the PQ.

Primary flexor tendons repair in zone 2: Current trends with GEMMSOR survey results.

The repair of flexor tendon lesions in zone 2 remains a highly controversial subject in hand surgery. Currently, there is no consensus about the management of these lesions intra- and postoperatively, but the literature suggests that a solid suture will allow early active motion. We hypothesized that the management of flexor tendon injury in zone 2 varies widely. Two online surveys were conducted with surgeons and hand therapists. The questions captured the demographics of the surveyed population, surgical technique, common complications, postoperative management (duration of immobilization, type of splint, rehabilitation techniques and principles of self-rehabilitation). The responses were compared to current literature data. We collected 366 responses to the "surgery" survey and 206 responses to "rehabilitation" survey. Most surgeons performed suture repair with at least 4 strands (75.9%). Active rehabilitation protocols were used in 48.9% of cases. The "rehabilitation" survey underlined the lack of information provided to therapists by surgeons. Therapists used active protocols in 79.7% of cases. This study found a large variation in the management of flexor tendon injuries, which is not always consistent with current published recommendations. Ideally, the suture repair should be a 4-strand pattern with an epitendinous circumferential suture and a release of the pulley in the suture area. Mobilization and rehabilitation should be started on the 3rd day using an active protocol.

Tendon rupture of the flexor digitorum profundus of the little finger secondary to hamate non-union.

Several cases of hamate fracture and non-union have been reported. The hook of the hamate acts as a pulley for the flexor tendons for the little and ring fingers. Hamate non-union is frequently associated with irritation of the adjacent soft tissues. We report the case of hamate non-union that was only detected because of a flexor digitorum profundus tendon rupture in the little finger, associated with tendinopathy of both flexor tendons of the ring finger.

[Management of zone 1 flexor digitorum profundus tendon injuries]. / Prise en charge des lésions du tendon fléchisseur profond des doigts en zone 1.

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.

Retrieval of the retracted flexor tendons for long fingers: New tip.

Zone II flexor tendon injuries continue to be a challenge for hand surgeons. During the injury event, the tendon ends may retract towards the palm. Retrieval of these lacerated ends can be problematic because the tendon sheath is unstretchable. This demanding surgery requires a precise repair technique where the tendon stumps are handled in an atraumatic manner. Microtrauma to the tendon sheath must be avoided as this can induce adhesions and lead to poor functional outcomes. Several retrieval methods for retracted tendon ends have been described in published studies. In this technical note, we will describe a technical variation that streamlines the surgical procedure and uses commonly available materials. This simple trick makes the procedure easier and avoids having to suture the tendon to the tubing.

Support for partial lesions of the flexor tendons of the fingers: a retrospective study of 36 cases.

The treatment of traumatic partial injuries of the flexor tendons of the fingers is seldom published. The only published clinical series states that the therapeutic approach depends on the existence or absence of a preoperative trigger. We hypothesized that the therapeutic attitude mainly depends on the percentage of the injured cross-section. Our retrospective series included 36 partial lesions of 31 fingers in 29 patients. The average age was 42 years, there were 19 men. We noted 8 lesions in zones I, 21 in zone II and 2 in zone III. The average percentage of the injured cross-section was 35% and ranged from 10% to 90%. If the lesion was less than 50% (29 tendons), a tangential resection was performed. If the lesion exceeded 50% (seven tendons), a direct suture was performed, supplemented by a running suture. At a follow-up of 34 months, the average pain on a visual analogue scale was 0.7. The average percentage of strength compared to the contralateral side was 93%. The Quick DASH score was 6.2. The range of motion averaged 214° with extremes ranging from 90° to 260°. We observed no cases of hypertrophic callus, neither through the MRI nor through the ultrasonography. Complications such as trigger finger, pseudoblocage or rupture were not observed. Based on our results, in case of partial injury of a flexor tendon, we propose to perform a tangential resection in cross-section lesions up to 50%, and a suture for those which exceeded 50%.