The authors retrospectively reviewed 23 consecutive patients who had a repair of the FDP tendon in Zone 1 using the button-over-nail technique. All injuries involved the FDP tendon insertion and all repairs were performed by the on call trainee surgeon. Ten patients (43%) experienced a complication related to the procedure: nail deformity, DIP joint flexion deformity, infection, and prolonged hypersensitivity. Two patients eventually underwent finger tip amputation to treat osteomyelitis (1 patient) and a fixed DIP flexion deformity (1 patient).
Previous studies of Zone 1 flexor tendon repairs have shown complication rates ranging from 35% (Gerbino and co-authors, JHS Am 1991) to 60% (Evans, JHT 1990). All surgical techniques for Zone 1 injuries, including buried transosseous sutures and suture anchors, carry inherent risk (e.g., anchor penetration into the DIP joint, DIP joint flexion deformity, nail bed injury, hypersensitivity, infection, etc.). Close supervision of surgeons in training and attention to detail are mandatory in minimizing the risk of complications. Patient education is important preoperatively.
Flexor, Tendon, Rupture, Avulsion, Button, Nail, Complications
Journal of Hand Surgery