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Novel Flexor Digitorum Superficialis Tenodesis for Traumatic Digit Amputation at the Level of the Proximal Phalanx
Maureen A. O'Shaughnessy, MD; Sanjeev Kakar, MD
Mayo Clinic, Rochester, MN

Introduction: When revision amputation at the level of the proximal phalanx is indicated, flexor digitorum superficialis (FDS) tenodesis is an intriguing management tool. Salvaging flexor function at the metacarpophalangeal joint (MCPJ) allows improved grip and function. To our knowledge this technique has not been described. This study reviews the outcomes of patients treated with FDS tenodesis. Traumatic amputation of the digit requiring revision amputation provides the opportunity to improve flexor function via tenodesis of remaining FDS tendons. Salvage of remaining FDS and performing tenodesis to the proximal phalanx allows flexion at the MCPJ which leads to improved hand function. Preserved flexion also improves prosthesis function if indicated.
Methods: IRB-approved retrospective study was performed of patients undergoing FDS tenodesis for amputation at the level of the proximal phalanx by the senior author. At latest follow up data including range of motion, grip strength and need for revision surgery were recorded.
Results: Twelve digits in 8 patients (7 male, 1 female) with average age at surgery of 57 (range 15-92) were included. Average follow up was 8 months (range 3-25). All patients sustained open, traumatic amputations. On average 3 digits were involved in trauma (range 1-5). Demographics included dominant hand involvement (4/8), smoker (2/8) and Workers' Compensation case (2/8). Average flexion-extension arc of affected metacarpal was 82 degrees (range 45-95) and average grip strength was 70% of unaffected extremity (range 50-100%). No patients required revision surgery or revision amputation. One patient had minor wound infection treated successfully with oral antibiotics.
Discussion and Conclusion:

  • FDS tenodesis is a reliable motion preserving procedure for amputations at the level of the proximal phalanx to maintain flexion at the MCPJ
  • In this series MCPJ flexion-extension arc measured 82 degrees on average at 8 months postoperatively
  • No major complications were noted
  • The significance of these results better enable surgeons to utilize FDS tenodesis in digital amputations at PIP level to preserve flexion at MCPJ for improved hand function after devastating traumatic injuries

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