Pull Thru Technique for FDP Reinsertion

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- Discussion:
    - in the case of FDP laceration, if cut is less than 1 cm from insertion, consider tendon advancement and reinsertion;
    - raise osteo-periosteal flap in distal phalanx, which is just distal to volar plate;
          - damage to the volar plate may lead to DIP flexion contracture;
          - in contrast, overly distal tendon insertion will also result in flexion contracture;
    - pass 3-0 prolene thru distal edge of tendon in a Bunnel weave pattern;
    - drill a small hole thru the middle of the distal phalanx which exit thru the mid aspect of nail (thru sterile matrix);
    - using Keith needle, pass these both suture arms thru the drill hole;
    - tie the prolene over felt and a button;
    - multiple strand repairs are stronger than single strand repairs;
    - suture anchors:
          - as noted by Silva et al 1998, suture anchors had significant weakness as compared to the dorsally placed button;
    - post operatively, the prolene can be pulled out after tendon healing has occurred;

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The effects of multiple strand suture techniques on the tensile properties of repair of the FDP tendon to bone.
      MJ Silva et al.   JBJS. Vol 80-A. No 10. Oct 1998. p 1507.