Orthopaedic Hand Trauma CH35

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SECTION 3  | Tendon Injuries

Kirschner wires, mini-fragment screws, or interosseous wires. A two-stage approach with independent repair of the tendon after fixation of the fracture is recommended in type IV and V injuries. ■ ■ Late management ● ● DIP arthrodesis is indicated as a salvage procedure in chronic injuries ( > 3 months) in patients with chronic stiffness. Reconstructing the FDP tendon with a tendon graft in a two-stage procedure can be considered in a select group of patients who require fine dexterity of the DIP joint for everyday life (ie, perhaps certain musicians and athletes). ■ ■ Postoperative protocol ● ● A forearm-based dorsal block splint is used with the wrist and meta- carpophalangeal joints held at 30° of flexion and the interphalangeal joints fully extended. A separate finger splint should be used for the injured fingers, holding the DIP in 45° of flexion for the first 3 weeks. Some passive movement is permitted at this stage but no active DIP flexion, wrist flexion, or finger extension. At the 4-week postoperative visit, the DIP finger splint can be removed and the forearm splint can be converted to a hand splint. Active motion can be initiated at this time. Return to resistive exercises is most commonly allowed at 8 weeks. ■ ■ The main complications after FDP avulsion injury repair are DIP joint stiffness and contracture. Studies estimate an average loss of 10 to 15° of extension after injury. There is also a risk of rerupture or loss of fix- ation postsurgical intervention. Another complication that can occur is quadriga caused by a functional shortening of the FDP tendon due to overadvancement of the FDP during repair, adhesions, or retraction of the tendon. The result is an inability to fully flex the fingers adjacent to the injured finger, which manifests as decreased grip strength. Ad- ditional complications can be seen with associated fractures, including decreased joint stability and arthrodesis. SUGGESTED READING Ruchelsman DE, Christoforou D, Wasserman B, Lee SK, Rettig ME. Avulsion injuries of the flexor digitorum profundus. J Am Acad Orthop Surg. 2011;19(3):152-162. COMPLICATIONS