The Pull-out K-wire Anchorage: The “Shepherd’s Crook” Technique

Abstract

Traditional pull-out techniques for tendon and ligament repair are still widely used in hand surgery, despite constant refinements and the development of other methods of fixation. We propose a modification of the classic technique which utilizes a K-wire as an external strut instead of the classic button. This fixation system can be usefully applied in the fixation of extensor and flexor tendons and reinsertions. It is particularly applicable in situations where a transarticular K-wire is to be used anyway, in situations of temporary joint immobilization and in other situations.

Free Chimeric Superficial Circumflex Iliac Artery Perforator Flap in Reconstructing the Distal Complex Extensor Tendon Injury

“…Solid tendinoosseous reattachment was initially achieved by a pull-out button technique of two-strand sutures tied over a button on the Vaseline-padded pulp. 14 Then, the fascia lata strip was approximated to the proximal stump of EPL/EHL under physiologic tension. The pedicle was tunneled to recipient vessels and microsurgically anastomosed to the feeding and draining vessel with 10-0 nylon.…”

The evidence-base for the management of flexor tendon injuries of the hand: Review

“…Furthermore, as sutures project externally there is a significant infection risk and snagging of the button and rupture of the repair have been reported [17]. The “Shepherd's Crook” repair is a simple variation using a k-wire as an external strut instead of the classic button [18]. This is particularly useful in situations where a trans -articular k-wire is to be used anyway and in situations requiring temporary joint immobilisation, but these are not pre-requisite.…”