Modified Pull-Out Technique for Zone One Flexor Digitorum Profundus Repair

Document Type : TECHNICAL NOTE

Authors

1 Ramsay Générale de Santé, Capio, Hôpital Privé Paul d’Egine, 4 avenue Marx Dormoy, Champigny-sur-Marne, France

2 Ramsay Générale de Santé, Capio, Clinique Jouvenet, Paris, France

Abstract

Pull-out suture fixation is widely used to fix zone one flexor tendon injuries. The original technique of Bunnell generally
has good results. However, in some cases, it may result in complications, including nail deformity and infection. The
all-inside techniques for fixation of the tendon at this zone cannot totally replace the Pull-out technique. In this article,
we propose a modification of the pull-out technique, which can reduce the complications and report the results of our
patients’ series.
Level of evidence: IV

Keywords


  1. Chepla KJ, Goitz RJ, Fowler JR. Anatomy of the flexor digitorum profundus insertion. J Hand Surg. 2015; 40(2):240–4. doi: 10.1016/j.jhsa.2014.11.004.
  2. Bunnell S. Primary repair of severed tendons the use of stainless steel wire. Am J Surg. 1940;47(2):502–16.
  3. Kang N, Marsh D, Dewar D. The morbidity of the button-over-nail technique for zone 1 flexor tendon repairs. Should we still be using this technique? J Hand Surg Eur Vol. 2008;33(5):566–70. doi: 10.1177/1753193408090118.
  4. Guinard D, Montanier F, Thomas D, Corcella D, Moutet F. The Mantero flexor tendon repair in zone 1. J Hand Surg Br. 1999; 24(2):148–51. doi: 10.1054/jhsb.1998.0173.
  5. Bidwai ASC, Feldberg L. The button-over-nail technique for Zone I flexor tendon injuries. Hand Surg. 2012; 17(3):365–9. doi: 10.1142/S0218810412500323.
  6. Tang JB, Giddins G. Why and how to report surgeons’ levels of expertise. J Hand Surg Eur Vol. 2016;41(4):365–6. doi: 10.1177/1753193416641590.
  7. Moiemen NS, Elliot D. Primary flexor tendon repair in zone 1. J Hand Surg Edinb Scotl. 2000; 25(1):78–84. doi: 10.1054/jhsb.1999.0319.
  8. Huq S, George S, Boyce DE. Zone 1 flexor tendon injuries: a review of the current treatment options for acute injuries. J Plast Reconstr Aesthetic Surg JPRAS. 2013; 66(8):1023–31. doi: 10.1016/j.bjps.2013.04.026.
  9. Al-Qattan MM. Type 5 avulsion of the insertion of the flexor digitorum profundus tendon. J Hand Surg Br. 2001; 26(5):427–31. doi: 10.1054/jhsb.2001.0619.
  10. McCallister WV, Ambrose HC, Katolik LI, Trumble TE. Comparison of pullout button versus suture anchor for zone I flexor tendon repair. J Hand Surg Am. 2006; 31(2):246–51. doi: 10.1016/j.jhsa.2005.10.020.
  11. Rigó IZ, Røkkum M. Comparison of Transverse Intraosseous Loop Technique and Pull Out Suture for Reinsertion of the Flexor Digitorum Profundus tendon. A Retrospective Study. J Hand Microsurg. 2013;5(2):68–73. doi: 10.1007/s12593-013-0100-8.
  12. Tempelaere C, Brun M, Doursounian L, Feron JM. Traumatic avulsion of the flexor digitorum profundus tendon. Jersey finger, a 29 cases report. Hand Surg Rehabil. 2017; 36(5):368–72. doi: 10.1016/j.hansur.2017.06.002.
  13. Chu JY, Chen T, Awad HA, Elfar J, Hammert WC. Comparison of an all-inside suture technique with traditional pull-out suture and suture anchor repair techniques for flexor digitorum profundus attachment to bone. J Hand Surg Am. 2013; 38(6):1084–90. doi: 10.1016/j.jhsa.2013.02.015.
  14. Matsuzaki H, Zaegel MA, Gelberman RH, Silva MJ. Effect of suture material and bone quality on the mechanical properties of zone I flexor tendon-bone reattachment with bone anchors. J Hand Surg Am. 2008; 33(5):709–17. doi: 10.1016/j.jhsa.2008.01.025.
  15. Polfer EM, Sabino JM, Katz RD. Zone I Flexor Digitorum Profundus Repair: A Surgical Technique. J Hand Surg Am. 2019; 44(2): 164.e1-164.e5. doi: 10.1016/j.jhsa.2018.08.015.