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Pull Thru Technique for FDP Reinsertion



- 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 through distal edge of tendon in a Bunnel weave pattern;
    - drill a small hole through the middle of the distal phalanx which exit thru the mid aspect of nail (through sterile matrix);
    - using Keith needle, pass these both suture arms through 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



The effects of multiple-strand suture techniques on the tensile properties of repair of the flexor digitorum profundus tendon to bone.