A 35-year-old carpenter sustains a complete laceration of the flexor digitorum profundus (FDP) of the ring finger in Zone II ('no man's land'). Primary repair is performed with a core suture. Which suture technique achieves the highest tensile strength for Zone II FDP repair?

• A Simple modified Kessler with running epitendinous suture
• B Four-strand Adelaide cross-lock suture
• C Six-strand cruciate (Savage) repair with epitendinous suture ✓
• D Bunnel criss-cross suture alone

Explanation

Tensile strength of flexor tendon repairs is directly proportional to the number of core suture strands crossing the repair site. Six-strand repairs (such as the Savage/cruciate technique) provide approximately 3× the breaking strength of the two-strand Kessler repair, enabling early active mobilization protocols without gap formation. The addition of a running circumferential epitendinous suture further adds 10–50% to gap resistance. Two-strand repairs are insufficient for early active motion protocols in Zone II.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.