The re-attachment of tendon and ligament avulsions

Miniplate and K-Wire Fixation for Type Vb Jersey Finger: A Case Series of 9 Patients

PURPOSE

The aim of this study was to present the results of plate and K-wire fixation for type Vb jersey finger.

METHODS

We used a miniplate system combined with a K-wire to treat 9 cases of acute type Vb jersey finger injury. The fracture healing time, functional outcomes, and complications were assessed.

RESULTS

The follow-up time ranged from 13 to 44 months. All fractures healed within 7 weeks. The mean active range of motion was 70.6° (60° to 80°) for the distal interphalangeal joint and 105° (100° to 110°) for the proximal interphalangeal joint. All affected fingers were able to move actively with no pain, and there was no nail deformity. Two patients with the longest radiographic follow-up showed a congruent joint surface with no degenerative change at 44 months.

CONCLUSIONS

Miniplate and K-wire fixation offers adequate fixation strength for the early initiation of active exercises so that a good functional result can be achieved.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic V.

Complications Following Transosseous Repair of Zone I Flexor Tendon Injuries

PURPOSE

Multiple techniques are described for repair of zone I flexor tendon injuries, many of which are fraught with complications. This study evaluated the clinical complications after a transosseous repair technique.

METHODS

A retrospective review of a single institutional database identified all zone I flexor digitorum profundus (FDP) injuries repaired using a transosseous technique. In this technique, 2 nonabsorbable sutures were passed from volar to dorsal through transosseous tunnels and tied dorsally over the distal phalanx proximal to the germinal matrix. Demographics, injury characteristics, operative details, and complications were reviewed.

RESULTS

Eight patients met the inclusion criteria. Average age was 31 years (range, 15-66 years) and all patients were male. Eight fingers were included: ring (4), small (3), and middle (1). Seven injuries were closed and one was open. Average time between injury and surgery was 13 days (range, 4-34 days). Five patients experienced complications, including osteomyelitis, chronic draining granuloma, and abnormal nail growth. Three patients required an additional operative procedure for management of complications.

CONCLUSIONS

Transosseous repair of zone I flexor digitorum profundus injuries with a buried dorsal suture is associated with a high rate of clinical complications.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic V.

Fingertip Winding Suture: Pull-out Suture Technique for Flexor Tendon Repair in Zone I

Injuries to flexor tendons in zone I has always been challenging during repair. Over the time several techniques were developed and modified to achieve the highest repair strength and thus the best functional outcome. These techniques vary from pull-out sutures with internal and external fixation to the use of bone anchors. All techniques were accompanied with advantages and disadvantages as well as postoperative morbidities related to certain techniques. In the present technique we introduce a subperiosteal pull-out suturing technique. It is a simple, strong, and cost-effective method for repair of flexor tendon injuries in zone I or in the context of tendon grafting.

Recent Nanotechnology Approaches for Prevention and Treatment of Biofilm-Associated Infections on Medical Devices

Bacterial colonization in the form of biofilms on surfaces causes persistent infections and is an issue of considerable concern to healthcare providers. There is an urgent need for novel antimicrobial or antibiofilm surfaces and biomedical devices that provide protection against biofilm formation and planktonic pathogens, including antibiotic resistant strains. In this context, recent developments in the material science and engineering fields and steady progress in the nanotechnology field have created opportunities to design new biomaterials and surfaces with anti-infective, antifouling, bactericidal, and antibiofilm properties. Here we review a number of the recently developed nanotechnology-based biomaterials and explain underlying strategies used to make antibiofilm surfaces.

[Management of zone 1 flexor digitorum profundus tendon injuries]

Flexor tendons repair in zone 1 is classically considered providing good results with an overall satisfactory finger function. However, the objective functional results after surgical repair of flexor digitorum profundus are sometimes disappointing. The authors describe the different surgical repair techniques available to the operator from so-called "traditional" sutures to newer methods of internal fixation using miniaturized anchor sutures. The management of postoperative procedures, that of failures and old cases are reported.

The morbidity of the button-over-nail technique for zone 1 flexor tendon repairs. Should we still be using this technique?

The button-over-nail technique is commonly used to fix the core suture to the distal phalanx for flexor digitorum profundus repairs in zone 1. We report a retrospective study of 23 consecutive patients who had a repair of the flexor digitorum profundus tendon in zone 1 using the button-over-nail technique. Fifteen patients experienced a complication, of which ten were directly related to the button-over-nail technique. Complications included nail deformities, fixed flexion deformities of the distal interphalangeal joint, infections and prolonged hypersensitivity. Two patients required amputation of the fingertip. We recommend that the button-over-nail technique should be avoided or used only with caution and with close attention to the details of the technique.

Direct tendon attachment and healing to porous tantalum: an experimental animal study

BACKGROUND

The ability to directly attach soft-tissue to metal would have broad clinical application. Previous attempts to obtain normal tendon-to-bone attachment strength have been unsuccessful. In the present study, we hypothesized that when the initial interface mechanical environment is carefully controlled, a highly porous form of tantalum metal would allow the ingrowth of tendon tissue with clinically relevant tendon-to-implant fixation strength approaching that of an intact tendon-to-bone insertion.

METHODS

Supraspinatus tendons from forty skeletally mature dogs were reattached to the greater tuberosity between two custom-designed porous tantalum washers. Clinical function as judged on the basis of gait analysis, reattachment fixation strength and stiffness, and tendon function as seen through muscle volume were evaluated preoperatively, immediately postoperatively, and at three, six, and twelve weeks after surgery. Qualitative and quantitative histomorphologic evaluation was performed at three, six, and twelve weeks after surgery.

RESULTS

Gait analysis with use of force-plate measurements demonstrated return to a normal gait pattern by three weeks after surgery. Tendon-implant strength as a percentage of normal, contralateral controls increased significantly, from 39% at the time of surgery to 67% at three weeks, 99% at six weeks, and 140% at twelve weeks (p < 0.0014). The stiffness of the construct also increased and approached that of normal tendon, measuring 47% at the time of surgery, 62% at three weeks, 94% at six weeks, and 130% at twelve weeks (p < 0.0299). Supraspinatus muscle volume initially decreased by 33% but recovered to 92% of normal by twelve weeks (p < 0.01). Histomorphologic evaluation showed Sharpey-like fibers inserting onto the surface of the porous tantalum. Quantitative histomorphometric analysis revealed a time-dependent increase in the density of the collagen tissue filling the metal voids below the implant surface of first the bottom washer and then the top washer.

CONCLUSIONS

Robust biologic ingrowth of tendon into a porous tantalum implant surface can be achieved under conditions of secure initial mechanical fixation. The strength and stiffness of the tendon-implant construct reached normal levels by six to twelve weeks in this animal model.

Miniplate fixation for avulsion injuries of the flexor digitorum profundus insertion

This article describes the use of a miniplate and cortical screws in the treatment of five cases of flexor digitorum profundus (FDP) tendon avulsion. One case was type II, three cases were type III and one case was type IV. Near normal joint congruity was restored together with bony union in all cases. Six months after surgery four cases had near normal range of motion at the distal interphalangeal joint compared with the contralateral uninjured finger. These four patients were to return to their previous activities without restriction by 3 months. One repair of a type III avulsion ruptured but the distal interphalangeal joint was pain free and stable and the patient declined further surgery. Miniplate fixation offers some advantages over existing methods of repair and adds to the range of techniques available for reattachment of the FDP tendon in these injuries.