Morbidity and Unplanned Secondary Surgery Following All-Inside Transosseous Flexor Tendon Repairs in Jersey Finger Injuries

<b>Background:</b> We hypothesised that the complication rate is correlated with the technique and the type of suture in all-inside transosseous flexor digitorum profundus (FDP) tendon repairs. <b>Methods:</b> A retrospective review of our database identified zone 1 injuries of FDP or flexor pollicis longus (FPL) that were repaired using the transosseous technique. In this method, two limbs of the nonabsorbable sutures are passed from volar to dorsal via transosseous tunnels and tied just proximal to the germinal matrix over the proximal aspect of the distal phalanx (dorsal to the terminal band). Demographics, operative details and complications were compiled. <b>Results:</b> Eleven patients met inclusion criteria with an average age of 35 years (range: 13-66) and an average follow-up of 7 months (range: 4-16). Sutures used included two Prolene, three Supramid and six FiberWires (Arthrex, USA). Three of these injuries were associated with distal phalanx fractures. Infection-like symptoms, including painful flare-ups of swelling of the eponychium, occurred in six patients (55%) in whom a braided suture was used, which included all three patients with Supramid and three patients with FiberWire (Arthrex, USA). Three of the patients experienced multiple episodes of painful swelling of the eponychium that were managed with antibiotics. Three patients (27%) experienced nail deformities. Eight (73%) of the eleven patients experienced complications, five requiring incision, drainage or subsequent suture removal. <b>Conclusions:</b> All-inside transosseous flexor tendon repair is correlated with a high complication rate mainly associated with suture abscess and nail deformity, with a high risk of needing additional intervention. We speculate that the braided sutures are more likely to cause recurrent symptoms of suture abscess. Although antibiotics may control the symptoms, the suture material should be occasionally removed in cases of recurrent suture abscesses. <b>Level of Evidence:</b> Level IV (Therapeutic).