Zone 2 Flexor Tendon Repair Location and Risk of Catching on the A2 Pulley
| Autor: | Perry R. Altman, Kanu S. Goyal, Miles W.A. Fisher |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
business.product_category
Flexor tendon repair genetic structures 030230 surgery Pulley Fingers Tendons 03 medical and health sciences 0302 clinical medicine Forearm Cadaver A2 pulley medicine Humans Orthopedics and Sports Medicine Range of Motion Articular Muscle Skeletal 030222 orthopedics Flexor tendon business.industry Anatomy musculoskeletal system Hand eye diseases Numerical digit Tendon Biomechanical Phenomena medicine.anatomical_structure Surgery sense organs business |
| Zdroj: | The Journal of hand surgery. 45(8) |
| ISSN: | 1531-6564 |
| Popis: | Purpose To determine the region of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons in zone 2 that, when involved by a laceration repair, will reliably catch on the A2 pulley after surgery. Methods Using fresh-frozen cadavers (5 hands, 20 digits), excursions of the FDP and FDS tendons were measured in relation to the A2 pulley. The C1, A3, and C2 pulleys were resected. The digit was maximally flexed by applying traction to the flexor tendon in the forearm. An 8-0 suture tag was placed in the flexor tendons immediately distal to the A2 pulley. The digit was then passively fully extended to measure tendon excursion. Measurements were repeated with 50% venting and 100% release of the A4 pulley. Reference points such as tendon insertions and flexion creases were obtained. This protocol was repeated sequentially for the index, middle, ring, and little fingers. Results For all 20 fingers, the suture placed into the FDP just distal to the A2 pulley with the finger fully flexed traveled 1.6 ± 1.9 mm distal to the proximal edge of the A4 pulley with passive extension of the finger. The mean excursion for the FDP was 24.6 ± 3.2 mm, and 16.9 ± 3.1 mm for the FDS. The mean A2 pulley length was 16.2 ± 3.5 mm, and the mean distance between the distal edge of the A2 pulley and the proximal edge of the A4 pulley was 23.0 ± 3.3 mm. Venting the A4 pulley 50% and 100% increased FDP excursion a maximum of 0.9 and 1.9 mm, respectively. Conclusions An FDP repair proximal to the A4 pulley will slide under the A2 pulley with full active digital flexion after surgery. If the distal FDP stump lies underneath the A4 pulley with the digit fully extended, the FDP repair will not likely engage the A2 pulley with full flexion after surgery. The FDP excursion can be reliably predicted as a percentage of the A2 (distal) to the A4 (distal) pulley distance. Most importantly, the distance between the repair site and the A4 pulley approximately equals the length of the A2 pulley that requires release to avoid postoperative triggering. Clinical relevance Knowledge of this high-risk region of flexor tendon repair will guide surgeons regarding the potential need for partial release of the A2 pulley. |
| Databáze: | OpenAIRE |
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