The morbidity of the button-over-nail technique for zone 1 flexor tendon repairs. Should we still be using this technique?

J Hand Surg Eur Vol. 2008 Oct;33(5):566-70. doi: 10.1177/1753193408090118.


The button-over-nail technique is commonly used to fix the core suture to the distal phalanx for flexor digitorum profundus repairs in zone 1. We report a retrospective study of 23 consecutive patients who had a repair of the flexor digitorum profundus tendon in zone 1 using the button-over-nail technique. Fifteen patients experienced a complication, of which ten were directly related to the button-over-nail technique. Complications included nail deformities, fixed flexion deformities of the distal interphalangeal joint, infections and prolonged hypersensitivity. Two patients required amputation of the fingertip. We recommend that the button-over-nail technique should be avoided or used only with caution and with close attention to the details of the technique.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Amputation
  • Child
  • Cohort Studies
  • Female
  • Finger Injuries / surgery*
  • Humans
  • Male
  • Middle Aged
  • Nails / surgery
  • Range of Motion, Articular
  • Reoperation
  • Retrospective Studies
  • Tendon Injuries / surgery*
  • Tenodesis / adverse effects*
  • Tenodesis / methods*
  • Treatment Failure
  • Young Adult