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A Novel Technique for the Treatment of Jersey Fingers

Publish date: May 9, 2018

References

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Transosseous tendon repair is a cost-effective option that obviates many complications commonly observed with other fixation methods. By keeping the suture within the body, the complications inherent in external sutures and buttons are eliminated, including the loss of fixation as a result of button or suture damage and facilitating hand hygiene maintenance. The rate of infection is also reduced. Moreover, the risk of nail deformities is decreased because the suture is not passed through the nail bed and nail plate in the described technique. Occasionally, some patients do note irritation from the dorsal suture knot under the thin skin proximal to the germinal matrix. This can be easily addressed in the clinic by removing the knot under local anesthesia following sufficient tendon healing. Additionally, the described technique can be used safely in pediatric patients with open physes because the needles can be placed to prevent violating the physis. This technique can be performed in conjunction with the skeletal fixation of type III, IV, and V jersey fingers. In our experience, the transosseous suture repair is more secure than the limited screw fixation, which can be accomplished in many type III jersey fingers, and in at least 1 case, has maintained flexor function when the skeletal fixation of the jersey finger has failed (Figures 5A, 5B).

All internal fixation techniques have been described previously by Sood and Elliot⁸ and, later, by Schultz and colleagues.⁹ In contrast to Sood and Elliott’s⁸ technique, which requires the creation of transverse tunnels, a volar-to-dorsal tunnel is technically easy to create and creates a direct repair to tendon insertion. Our technique is similar to that of Schultz and colleagues'⁹ but has the following differences and potential improvements:

Keith needles are passed in a volar-to-dorsal fashion, thus allowing for the direct visualization of the transosseous tunnel origin, minimizing the size of the transosseous tunnels, and allowing for the anatomic reduction of the tendon.
Fluoroscopy is used to confirm wire placement prior to skin incision, thus enabling precise placement and potentially allowing the needles to be placed so as to avoid physeal injury in pediatric jersey fingers.
By using Keith needles, sutures can be passed with the same instrument that created the tunnel, thus simplifying surgical technique.
A Krakow suture technique is used. This technique results in less gapping and higher load-to-failure than other suturing techniques.²²
A 2-0 braided suture is used, therefore strengthening repair.

This paper will be judged for the Resident Writer’s Award.