12:45

Reattachment of Flexor digitorum profundus (FDP) tendon using mini-mitek bone anchor. surgical technique

Overview

Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.

SUBSCRIBE


Learn the Reattachment of Flexor digitorum profundus (FDP) tendon using mini-mitek bone anchor. surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Reattachment of Flexor digitorum profundus (FDP) tendon using mini-mitek bone anchor. surgical procedure.

Avulsion injuries of flexor tendons injuries occur usually as part of contact sports. Flexor Digitorum Profundus of the ring finger is the most commonly effected one. These are eponymously sometimes called “Jersey finger” as often these injuries occur when the finger is caught in a player’s jersey during contact. The tendon may be avulsed cleanly from the bone or may become detached with a piece of the phalangeal bone. These injuries have been classified by Leddy and Packer into three types:

Type 1. No bony fragment and the tendon retracts into A1 pulley area.

Type 2: A small bony fragment and the tendon retracts into the A3 pulley area as the bone fragment is caught in the chiasma of the FDS slips

Type 3: A large bony fragment resulting in no significant retraction as the fragment cannot pass through the sheath.

A Type 4 has later been added which equates to a Type 3 where the bone has then detached from the tendon which retracts into the A1 pulley.

Patients often present late after the event. The nature of an adrenaline charged contact sport means these injuries are often ignored at the time and it is only when the swelling and pain ensues that the loss of movements of the finger is noted.

On examination there is swelling and bruising around the finger when they present early. Patients are unable to flex the DIP joint actively.

The treatment depends on the type of injury. If the tendons has been avulsed off without a bony fragment, the finger is explored through a zig-zag incision and the tendon end retrieved. It is reattached using a variety of methods. These include drilling into bone and passing a non-absorbable suture from the tendon into the bone, passing the suture across the nail and tying it over a button or a sponge, or reattaching it using a bony anchor. If there is a substantial bone fragment, it has to reattached using screws or a small plate and screws. If the bony fragment is small it can be excised and tendon reattached .

If presenting later than two weeks the tendon may shorten especially in Type 3 injuries. If during the operation the tendon is found tight and even on stretching does not reach the distal phalanx and decision has to be made as to whether a primary tendon grafting should be considered or to do a DIP joint fusion at a  later date. Undue flexion of the finger from a very tight repair can result in PIP and DIP joint contractures which may not correctable later.

In these cases patients should be counselled about the merits and risks of tendon reconstruction. If the lack of DIP joint flexion is not a significant problem, it is better to leave it alone. If patient’s functional demands require the DIP joint to be in flexion, then a DIP joint fusion is a simpler and effective alternative to tendon reconstruction.

 

 

Author: Mr Rajive Jose FRCS.

Institution: The Queen Elizabeth Hospital, Birmingham, UK

Feedback

  • Each operation and the questions associated become a named course in the CPD section
  • The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
  • You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
  • The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
  • There are four possible answers of which one is correct (or on occasion more correct) than the others.
  • There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
  • The course is completed once all the lessons are read and quizzes submitted and passed.
  • On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
  • Your dashboard also will contain a record of the time you have spent logged onto and using the site.
  • The timer suspends after 5 minutes though if there is no activity.
  • When you restart you will resume at the same point in the module.
  • Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
    The pass mark is 75%.
  • If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
  • Once these have been read you can re-do just the questions you failed on.
  • Once you have passed the quiz you can return at a future stage & resit .

CPD Points:

  • Operation Quiz – 1 CPD point
  • Surgical steps Quiz – 1/4 CPD point
  • Implants Quiz – 1/4 CPD point
  • Problem case Quiz – 1/2 CPD point

One CPD point equates to one hour of academic activity

COURSE

Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.

Our content is designed for both Surgeons in independent practice and Surgeons in training.

COURSE PROGRESS

Lessons Status

Accreditations

Logo Logo Logo Logo Logo

Associates & Partners

Logo Logo Logo Logo Logo