The Morbidity of the Button-over-Nail Technique for Zone 1 Flexor                     Tendon Repairs. Should we still be using this Technique?

Kang, Norbert; Marsh, Daniel; Dewar, Donald

doi:10.1177/1753193408090118

Cited by 55 publications

(29 citation statements)

References 15 publications

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“…Distal fixation of the graft has been performed through a number of techniques over the years (Wilson and Sammut, 2003), although the use of bone anchors for distal attachment has been recently preferred (Brustein et al, 2001;Latendresse et al, 2005;McCallister et al, 2006). We opted for the button-on-the-nail technique, but acknowledge risk of nail deformity, looseness, and infection (Kang et al, 2008). We did not use bone anchors for distal attachment because as they are rather large for the distal phalanx in children.…”

Section: Discussionmentioning

confidence: 96%

Long term results of early active extension and passive flexion mobilization following one-stage tendon grafting for neglected injuries of the flexor digitorum profundus in children

Yamazaki

Kato

Uchiyama

et al. 2011

J Hand Surg Eur Vol

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We retrospectively reviewed the long-term clinical outcomes of one-stage flexor tendon grafting for seven paediatric patients with isolated flexor digitorum profundus (FDP) tendon injuries in Zones 1 or 2. Free tendon grafts (one palmaris longus tendons and six plantaris tendons) were used for reconstruction by Pulvertaft's procedure. The ages of the patients at reconstruction ranged from 7 to 15 (mean 11) years. The time from injury to surgery ranged from three to 78 (mean 25) months. These patients were followed up from 2.5 to 21 years after surgery (mean 8.5 years). All cases were started on early active extension and passive flexion according to the modified Kleinert mobilization for postoperative rehabilitation. The mean active motion after surgery was 49° (range 20-80°) for the DIP joints and 106° (range 95-110°) for the PIP joints. The total active range of motion was on average 237° (range 195-275°). Excellent results were achieved in five patients, good in one, and fair in one. Growth arrest of the distal phalanx was seen in one patient. One-stage flexor tendon grafting in paediatric patients combined with early controlled mobilization can be used to reconstruct neglected isolated ruptures of the FDP tendon with satisfactory results.

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Section: Discussionmentioning

confidence: 96%

Long term results of early active extension and passive flexion mobilization following one-stage tendon grafting for neglected injuries of the flexor digitorum profundus in children

Yamazaki

Kato

Uchiyama

et al. 2011

J Hand Surg Eur Vol

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“…4 However, there are many disadvantages of this pullout suture technique, including discomfort, pain, suture wire rupture, difficulty in daily care of the bolster, infection, skin necrosis, and nail bed injury. 5,6 In order to avoid these complications, anchored bone suture was proposed to reattach the FDP tendon to the distal phalanx. Brustein's study 12 revealed that the bone suture anchor provides a stronger tendon-to-bone repair than the pullout button technique.…”

Section: Discussionmentioning

confidence: 99%

“…The hook of the device was used to hook the small avulsed bone fragment and to hold the FDP tendon (Figs. 3,4,5). A finger splint was used to immobilize and protect the little finger for 6 weeks.…”

Section: Case Reportmentioning

confidence: 99%

“…Other disadvantages include pullout suture rupture, nail bed injury, and inconvenience for the patient. 5,6 In order to avoid these complications, many forms of bone suture anchor 7 and transosseous suture 8,9 techniques have been proposed. For type III avulsion injury with larger bone fragments, interosseous wiring, 10 cross K-wires, or screws 11 are used for rigid fixation of the fractured bone fragments; Kang 6 has also presented miniplate and cortical screw fixation of the avulsed fragments in 5 cases of FDP avulsion.…”

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confidence: 99%

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

Chen

Liu

et al. 2009

The Journal of Hand Surgery

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“…Clinical complications include nail deformities and prolonged hypersensitivity (10). Also, due to its external location, the button may be pulled and result in failure of the tendon reattachment or cause infection (3, 10). …”

Section: Discussionmentioning

confidence: 99%

Comparison of an All-Inside Suture Technique With Traditional Pull-Out Suture and Suture Anchor Repair Techniques for Flexor Digitorum Profundus Attachment to Bone

Chu

Chen

Awad

et al. 2013

The Journal of Hand Surgery

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Purpose One goal in repairing Zone 1 flexor digitorum profundus (FDP) injuries is to create a tendon-bone construct strong enough to allow early rehabilitation while minimizing morbidity. This study introduces an alternative all-inside suture repair technique and compares it biomechanically with pull-out suture and double suture anchor repairs. Methods Repairs were performed on thirty cadaver fingers. In all-inside suture repairs (n=8), the FDP tendon was attached to bone with two 3-0 Ethibond sutures and tied over the dorsal aspect of distal phalanx. Pull-out suture repairs (n=8) were performed with 2-0 Prolene suture and tied over a dorsal button. There were two suture anchor repair groups: Arthrex Micro Corkscrew anchors preloaded with 2-0 FiberWire suture (n=7) and Depuy Micro Mitek anchors preloaded with 3-0 Orthocord suture (n=7). Repair constructs were tested using a servohydraulic materials testing system and loaded until the repair lost 75% of its strength. Results There were no statistically significant differences in tensile stiffness, ultimate load, or work to failure between the repairs. Failure mode was suture stretch and gap formation >2mm at the repair site for all pull-out suture repairs and 7 of 8 all-inside suture repairs. Two of the Arthrex Micro Corkscrew repairs and five of the Depuy Micro Mitek repairs failed by anchor pull out. Conclusions This cadaveric biomechanical study showed no difference in tensile stiffness, ultimate load, and work to failures between an all-inside suture repair technique for zone 1 FDP repairs and previously described pull-out suture and suture anchor repair techniques. The all-inside suture technique also has the advantages of avoiding an external button and the cost of anchors. Therefore, it should be considered as an alternative to other techniques. Clinical Relevance This study introduces a new FDP reattachment technique that avoids some of the complications of current techniques.

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The Morbidity of the Button-over-Nail Technique for Zone 1 Flexor Tendon Repairs. Should we still be using this Technique?

Cited by 55 publications

References 15 publications

Long term results of early active extension and passive flexion mobilization following one-stage tendon grafting for neglected injuries of the flexor digitorum profundus in children

Long term results of early active extension and passive flexion mobilization following one-stage tendon grafting for neglected injuries of the flexor digitorum profundus in children

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

Comparison of an All-Inside Suture Technique With Traditional Pull-Out Suture and Suture Anchor Repair Techniques for Flexor Digitorum Profundus Attachment to Bone

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