FDP
CAMPERs CHIASMA
FDS divides and passes around the FDP tendon, the two portions of the FDS reunite at Campers Chiasma
PULLEYS
Preserve A2 and A4 pulley to prevent bowstringing. NOTE: There is a mistake in this diagram: The C1 pulley is DISTAL to the A2 pulley!
BLOOD SUPPLY
Segmental branches of digital arteries which enter the tendon through:
vincula osseous insertions
ZONES
COMPLICATIONS
Stiffness Re-rupture Tenolysis may be required in an estimated 18% to 25% of patients
No earlier than 3 months after repair If no ROM improvement for 1-2 months
TENDON HEALING
SUTURE TECHNIQUES
Kessler
Modified Kessler
(1 suture)
Advantage: Only one node inside the repair site. Easier to use a monofilament suture like a 4.0 Proline to re-approximate tendon edges.
Kessler-Tajima
(2 sutures)
SUTURE MATERIAL
Non-absorbable Most authors prefer a synthetic braided 3.0 or 4.0 suture, usually of polyester material (Mersilene, Tycron, Tevdek) However, monofilament sutures like nylon and wire are also used (e.g. Proline) Additional running, circumferential 5-0 or 6-0 nylon is used often
POST-OP PROTOCOLS
1. Kleinert: Active extension, passive flexion by rubber bands 2. Duran: Controlled Passive Motion Methods 3. Strickland: Early active ROM
Kleinert Protocol
COMPLICATIONS
Joint contracture Adhesions Rupture Bowstringing Infection