Miniplate Hooking Method for Repair of Type III Flexor Digitorum Profundus Avulsion Injury With a Small Bone Fragment: Case Report

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.…”

“…This surgical option allows the neutralization of deforming forces produced by the pull of FPD, transforming them into a perpendicular force distributed along healthy bone as well as reducing penetration of bony fragment with a consequent risk of fragment destruction increasing comminution. 11 The distal placement of the miniscrew prevents excessive tendon damage during surgery. The hooking plate composition allows fixation of small or comminuted fragments all-in-one, providing backup fixation.…”

“…The hooking plate composition allows fixation of small or comminuted fragments all-in-one, providing backup fixation. 11 Moreover, the advantages of this surgical option include avoiding concerns associated with external fixations and providing option of doing early mobilization due to stable fixation. 5 Hook plates placed in volar distal phalanx with miniscrew emerge as surgical treatment for FDP avulsion types II and III in flexor zone 1, with excellent clinical outcomes and no associated morbidity.…”

“…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. This technique allows us to overcome some disadvantages of other techniques such as fixation of small fragments, reducing risk of fragment comminution during procedure, distributing pull forces far from the fracture, and allowing early mobilization.…”

“…This technique allows us to overcome some disadvantages of other techniques such as fixation of small fragments, reducing risk of fragment comminution during procedure, distributing pull forces far from the fracture, and allowing early mobilization. 10,11 The aim of this report was to assess whether hook volar plate and screw was an accessible and reliable option in terms of clinical outcomes and surgical technique to repair FDP avulsion types II and III in flexor zone 1 by overcoming lack of strength and avoiding collateral damage.…”