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The Effect of Flexor Digitorum Profundus Tendon Advancement on the Development of Quadrigia Syndrome in the Treatment of Jersey Finger: A Biomechanical Study
Michael Devon Smith, MD; Charles Daly; Claude Jarrett
Emory University, Atlanta, GA

Introduction: There is a commonly held belief amongst hand surgeons that the advancement of the flexor digitorum profundus (FDP) tendon more than one centimeter during the repair of a jersey finger will lead to quadrigia syndrome. We hypothesized that there would be no difference in the force required to form a fist with advancement of the FDP to distances greater than 1.0cm when compared to 1.0cm or less.
Materials & Methods: Six fresh frozen cadaver forearms were utilized. The FDP muscle belly was dissected and isolated at its musculo-tendinous junction and the FDP tendon to the ring finger was identified at its insertion into the distal phalanx. A horizontal clamp was placed across the FDP muscle and the force in pounds required to pull the finger tips of the small, ring, middle and index fingers to the palm was measured. Ten measurements were taken for each forearm prior to ring FDP release and at 0.5cm, 1.0cm and 1.5cm of advancement. The resultant force measurements required to form a fist amongst all the forearms were then analyzed using the Kruskal-Wallis test, a non-parametric and method. The force required at the resultant levels of advancement were compared against each other level of advancement within individual forearms and across the cohort of forearms using the Wilcoxon Two-Sample test.
Results: The average resultant force required to form a fist prior to FDP release was 20.7lbs. At 0.5cm, 1.0cm, and 1.5cm the average force was 26.9lbs, 32.5lbs, and 33.0lbs respectively. There was a significant difference in the force required to form a fist with 0.5cm and 1.0cm of advancement when compared to no advancement or 0.5cm of advancement (p < 0.0001). There was no statistically significant difference in the force required to form a fist with 1.5cm of advancement compared to 1.0cm of advancement (p = 0.4376).
Conclusions: Our cadaver based study provides biomechanical evidence that there is a consistent increase in the force required to form a fist with advancement of the FDP of the ring finger up to 1.0cm. After advancement to a distance greater than 1.0cm, there is a plateau effect in which the subsequent force required to form a fist is not significantly increased. This data suggests that if advancement of the FDP tendon up to 1.5cm is required for operative repair of a jersey finger, there may be no additional risk of developing quadrigia syndrome than advancement to 1.0cm.


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