A new technique of flexor profundus repair in the distal part of zone I: inclusion of the palmar plate

Abstract

Flexor profundus lacerations in the distal part of zone I are usually treated by tendon reinsertion into bone. We present a modified technique in which three 'figure of eight' sutures include the palmar plate in the distal purchase. Inclusion of the palmar plate significantly strengthens the tensile strength of the repair and this was confirmed biomechanically in an experimental study. In a prospective clinical study, 15 patients with clean-cut complete lacerations of the profundus tendon in the distal part of zone I underwent the modified repair technique of three separate 'figure of eight' sutures with the palmar plate included in the suture distally and 7 mm suture purchase proximally, with postoperative immediate active motion that ensured full active extension of the interphalangeal joints. There were no ruptures or infections. At final follow-up 12-25 weeks after surgery, the mean range of motion at the distal, proximal, and combined interphalangeal joints was 66 degrees, 100 degrees and 166 degrees respectively. All patients achieved an excellent or good outcome.

Zone I Flexor Profundus Tendon Repair in Children 5–10 Years of Age Using 3 “Figure of Eight” Sutures Followed by Immediate Active Mobilization

“…10 Biomechanically, this technique is known to be more than 2.5 times stronger than the standard Bunnell pullout suture technique 12 (107.9 vs. 42.4 N). We reviewed pediatric series on flexor tendon injuries in the English medical literature over the last 20 years and found a total of 19 reported cases (Table 3) of zone Ia profundus tendon lacerations.…”

“…2), there was not sufficient tendon length for distal purchase of the core suture, and hence repair was done using Al-Qattan technique of inclusion of the palmar plate in the distal purchase. 10 Three separate figure of 8 sutures (4/0 polypropylene) were used for repair. Proximally, suture purchase was 2 mm longer than the width of the tendon.…”

Repair of flexor digitorum profundus avulsions including the palmar plate: a retrospective comparative study of 56 cases

“…In a more recent version of his work, Al-Qattan (2016) changed his surgical technique to an end-to-end repair of the tendon to the palmar plate after releasing its proximal attachment. Based on these findings, we combined the pull-out suture technique with the original technique described by Al-Qattan et al (2010) and aimed to achieve a more robust repair that could withstand early active rehabilitation with minimal complications. Additionally, the combination of a Bunnell non-locking pull-out suture and two locking modified Kessler suture types augments the strength of repair.…”

“…Results are nearly equal (Chu et al., 2013; Ruchelsman et al., 2011). Al-Qattan et al. (2010) have introduced the concept of repair with inclusion of the distal palmar plate and have reported an increase of load to failure by 100 N, which is favourable considering that the load to failure of the normal FDP bone interface is 119 N (Brustein et al., 2001).…”

Flexor tendon injuries in the child

“…In Zone IA, I prefer to suture the proximal tendon into both the short distal stump and the palmar plate of the DIP joint. Including the plate significantly increases the tensile strength of the repair and makes the procedure simpler (Al-Qattan et al, 2010). To avoid growth plate injury when using this technique in children, one should be careful not to go through the physis of the distal phalanx when suturing into the palmar plate.…”