The FDP tendons enter the fibro-osseous flexor sheaths alongside the FDS tendons, passing through the Camper chiasm (the splitting of the FDS into two slips) to reach the distal phalanx. The index FDP has an independent muscle belly; the middle, ring, and little FDP tendons share a common belly (quadriga effect). Zone II (no man's land) repairs of the FDP require meticulous four-strand technique and controlled early active motion rehabilitation.
DIP joint flexion force transmission; the only DIP flexor
Zone II FDP repair (between the A1 pulley and the FDS insertion) is the most technically demanding flexor tendon zone — both FDS and FDP are in close proximity within the tight fibro-osseous sheath. The Strickland protocol of modified Kessler core suture plus epitendinous running suture achieves adequate gap resistance for early active motion starting on day 3-5 post-repair.
Combined FDP and FDS division requiring meticulous four-strand core suture repair with epitendinous suture followed by controlled early active motion rehabilitation.
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