Distal Phalanx Osteomyelitis Complicating Zone I Flexor Tendon Repair with a Non-Pullout Suture Tied Over a Dorsal Button: A Report of Two Cases.

Abstract

Traditional methods for flexor tendon-to-bone repair, such as zone I flexor tendon injuries or distal graft fixation in flexor tendon reconstruction, include a pullout suture tied over a dorsal button as described by Bunnell1-8. However, locking suture techniques have a higher load to failure than nonlocking configurations9-13; a non-pullout locking suture configuration previously has been described14,15. With use of this technique, the non-pullout suture is cut flush with the nail at the time of button removal, leaving suture material within the distal phalanx and tendon. Complications of a tie-over button method include nail deformity5,6,16-18, perionychial irritation or necrosis6,16,19, and infection5,6,16-22. We present two cases of delayed presentation of distal phalanx osteomyelitis after zone I flexor tendon repair with a non-pullout suture configuration that was tied over a dorsal button. Both patients were informed that data concerning their cases would be submitted for publication, and they provided consent. Case 1. A healthy twenty-eight-year-old man with a closed distal flexor digitorum profundus (FDP) avulsion injury of the left ring finger underwent surgical repair ten days after injury. We performed an eight-strand modified Becker technique with use of 3-0 looped Supramid suture (S. Jackson, Alexandria, Virginia) tied over a well-padded polypropylene suture button. Sutures were placed 3 mm apart through the distal phalanx with straight Keith needles; the needles were drilled from the midpoint of the FDP insertion, exiting the midportion of the sterile nail matrix. Preoperative antibiotics were administered intravenously within one hour of surgery. There were no perioperative complications. Rehabilitation emphasizing early motion and tenodesis as a low force/high excursion protocol was initiated under the supervision …