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New "loop" suture for FDP zone I injuries.

Martins Kapickis1

  • 1Center of Plastic Surgery and Microsurgery of Latvia, Riga, Latvia. kapickis@dr.com

Techniques in Hand & Upper Extremity Surgery
|September 5, 2009
PubMed
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A novel buttonless suture technique offers an affordable and effective method for flexor tendon repair, avoiding complications associated with traditional pullout sutures. This approach simplifies distal juncture fixation for flexor digitorum profundus (FDP) injuries.

Area of Science:

  • Orthopedic Surgery
  • Hand Surgery
  • Biomedical Engineering

Background:

  • Existing distal juncture fixation techniques for flexor digitorum profundus (FDP) injuries often rely on expensive, technology-dependent methods.
  • The popular Bunnell pullout technique, while allowing suture removal, necessitates a tie-over button, leading to potential complications like maceration and infection.
  • There is a need for cost-effective and less invasive fixation methods for FDP tendon injuries.

Purpose of the Study:

  • To introduce and evaluate a new, buttonless tendon-to-bone fixation method for distal flexor tendon repair.
  • To assess the feasibility and preliminary outcomes of this technique in patients with FDP injuries or undergoing tendon reconstruction.

Main Methods:

  • A buttonless tendon-to-bone fixation technique was developed and implemented.

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  • A preliminary study included twelve patients: seven with acute FDP tendon zone I bone juncture injuries and five undergoing second-stage flexor tendon reconstruction with grafts.
  • The technique involves retaining the suture, simplifying the procedure and reducing costs compared to anchor sutures.

    • Main Results:

    • No infections, FDP ruptures, or nail growth disturbances were observed in the twelve patients.
    • Three patients experienced slight distal interphalangeal (DIP) joint flexion contracture.
    • One patient developed a mallet deformity, indicating a need for careful technique application.

    Conclusions:

    • The proposed buttonless tendon-to-bone fixation is easy to perform and cost-effective, comparable to standard Bunnell fixation.
    • This method effectively excludes complications associated with traditional pullout sutures.
    • While bone suture anchors offer superior tensile strength, this affordable technique provides a viable alternative for hand surgeons facing cost limitations.