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Flexor Digitorum Profundus Avulsions: A Cadaveric Comparison of Three Reconstructive Techniques
Jonathan Isaacs, MD1; Ravinder Brar, MD1; Glenn Gaston, MD2; Raymond Melikian, BA1; John Owen, BS1; Jennifer Wayne, PhD1
1Virginia Commonwealth University Health System, Richmond, VA; 2Carolinas Medical Center, Charlotte, NC

Background: Flexor digitorum profundus (FDP) avulsion injuries are relatively common. There are several methods for repair of these injuries; however, no consensus exists on the best technique. An ideal repair would be strong enough to withstand forces generated by active motion rehabilitation post-operatively. Active motion protocols are warranted to prevent complications from adhesions and joint contractures.
Purpose: To demonstrate if including the volar plate in an FDP reconstruction strengthens the reconstruction enough to sustain loads that permit active digital motion post-operatively.
Methods: Eighteen fresh-frozen cadaveric fingers were divided into three reconstruction groups (N = 6 each). The first technique was two micro suture anchors (A). The second was a volar plate reconstruction alone (VP). Lastly, the third group was a hybrid, combining a single micro anchor with volar plate augmentation (AVP). After repair the specimens were loaded cyclically from 2 to 15 N at 5 N/s, for a total of 500 cycles. Gap formation was assessed every 100 cycles. Finally, specimens were tested to failure at 0.33 mm/s after completion of 500 cycles.
Results: For all repair types, gapping after cycling was significantly greater than at the start of the first cycle (p<0.0001). The A group experienced significantly more gapping after cycling than the VP and AVP groups (p<0.005). No difference in gapping after cycling was detected between VP and AVP groups (p=0.4463). The A group failed at a significantly lower load than VP and AVP (p<0.005). No difference in failure load was detected between VP and AVP (p>0.44).
Conclusions: Incorporating the volar plate in an FDP reconstruction strengthens the reconstruction significantly and may allow for early, active motion post-operatively. More studies are warranted to investigate the clinical outcomes of volar plate inclusion.


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