Fixation of a Type 3 Flexor Digitorum Avulsion Injury

Abstract

This article describes a novel technique for flexor digitorum profundus (FDP) avulsion injuries, useful for Leddy Packer type 3, 4, and 5 injuries. Multidirectional stability is achieved with combination pull-out suture, which neutralizes the deforming force of FDP, and cerclage wire, which holds the bone fragment in an anatomic position and provides interfragmentary compression. Traditional techniques such as interosseous wires, Kirschner wires, or plating risk fragment comminution and loss of reduction due to proximal pull of FDP as demonstrated in this case report of failed Kirschner-wire fixation. The technique presented here eliminates the risk of avulsion fragment comminution and provides stable fixation that allows for early mobilization.

Hook Plate as a Treatment for Flexor Digitorum Profundus Avulsion Types II and III

“…Flexor digitorum profundus avulsion repair has been approached by multiple techniques and variations during the last decades, including treatment by pullout button sutures, 4,7,8 anchor button sutures, 12 anchor sutures, [3][4][5][6] anchor sutures and screws, 13 other techniques, [14][15][16] miniscrews, 8 cerclage wire, 9 and plates 10,11 (Table 1). All these techniques had tried to overcome, regarding the previous literature, the difficulty in surgical fixation in a location with limited access to ligaments and tendons and a reduced space around finger joints with high risks of tendon damage.…”

“…20 However, external fixation techniques have been associated with a higher number of complications such as infections, skin irritation, rupture of sutures, and nail matrix alterations. 4,7 In light of the above, recent literature has proposed improved surgical approaches such as suture anchors with buried backup fixation with transosseus tunnels, 5,18 pullout sutures with wire cerclages, 9 suture anchors with miniscrew, 13,17 mini-fragment screws, 8 suture to volar plate, 15,19 or simple wire interosseous fixation. 16 Kang et al 10 performed a reinsertion with volar plates in 2003.…”

“…1,2 The injury mostly occurs due to a hyperextension of the distal interphalangeal (DIP) joint while FDP is contracted. 1 During the past 20 years, this injury been treated, and a wide range of surgical techniques and variations to fix avulsed fragments and FDP tendons have been proposed, including anchor sutures, [3][4][5][6] pullout button sutures, 4,7,8 miniscrews, 8 cerclage wire, 9 and plates 10,11 In reviewing the literature, due to the difficulty in surgical fixation of fragments around finger joints, limited access to ligaments and tendons, risk of tendon damage, and the lack of cases, none of the surgical techniques have turned out as a clear consensus option above others. As an alternative, we present an internal fixation procedure with a hook plate and a miniscrew with reference to the technique that Chen et al 11 proposed in 2009 based on volar plates of Kang et al 10 in 2003.…”

“…During the past 20 years, this injury been treated, and a wide range of surgical techniques and variations to fix avulsed fragments and FDP tendons have been proposed, including anchor sutures, 3-6 pullout button sutures, 4,7,8 miniscrews, 8 cerclage wire, 9 and plates 10,11…”