Surgical Repair of Multiple Pulley Injuries—Evaluation of a New Combined Pulley Repair

Evaluation of finger A3 pulley rupture in the crimp grip position—a magnetic resonance imaging cadaver study

“…Recent studies have suggested conservative treatment for single pulley rupture without clinical bowstringing [1,33]. A surgical treatment with operative pulley reconstruction was proposed for combined pulley rupture for patients with evidence of clinical bowstringing and/or a loss of full range of motion [1,20,34,35]. Radiological imaging of pulley ruptures is recommended for managing the treatment and predicting the clinical outcome [12,13,24].…”

Intermittent unspecific osteitis and cortex atrophy of the proximal phalanx after surgical pulley repair

“…Following standard procedure for multiple pulley ruptures, we set the indication for surgical repair. On 25 March, we performed the surgery using a modified ‘one-and-a-half-loop’ and ‘Weilby’ technique,2 for which a palmaris longus reconstruction of the same arm was used. Subsequent after-treatment was arranged following our standard ‘pulley schema’, which provides immobilisation in a splint (intrinsic plus position) for the first 2 weeks, followed by a 4 week mobilisation phase with pulley protection (thermoplastic pulley protection ring).…”

“…For exact evaluation, we investigated different indicators: for the clinical outcome, we used the Buck-Gramcko score, which showed an excellent result2; the functional outcome was good,2 as there was a minor extension deficit in the PIP joint, subjective loss of strength only in the crimping position and normal motion pattern 2. The sport-specific outcome was also good,2 as the patient had a full-load capacity of the former injured finger in the hanging position, a minor loss of strength in the crimping position and a nearly full climbing ability without any pain (general reduction of climbing intensity due to new professional position).…”

“…The actual consensus on how to handle multiple pulley rupture situations recommends surgery whereas single pulley ruptures require conservative therapy 2. Following these guidelines, we regularly perform surgery in multiple pulley tears.…”

“…Following these guidelines, we regularly perform surgery in multiple pulley tears. As we usually see few complications or problems in after-treatment following the ‘bone-encircling’ technique recommended for climbers (modified ‘one-and-a-half-loop’—technique),2 we investigated two athletes with the same unexpected complaints and symptoms more than 1 year after surgery.…”