Introduction The quadriga effect is characterized by an active flexion lag in fingers adjacent to a digit with a previously injured or repaired flexor digitorum profundus tendon. Mechanism most commonly caused by a functional shortening of the FDP tendon due to over-advancement of the FDP during tendon repair >1 cm advancement associated with quadriga adhesions retraction of the tendon "over-the-top" FDP repair of the distal phalanx after amputation Pathoanatomy FDP tendons of long, ring, and little fingers share a common muscle belly therefore excursion of the combined tendons is equal to the shortest tendon improper shortening of a tendon during repair results in inability to fully flex adjacent fingers Anatomy Flexor digitorum profundus Zones of the flexor tendons most injuries resulting in quadrigia involve Zone I Presentation Symptoms inability to fully flex the fingers of the hand adjacent to the injured finger patient may complain of "weak grip" Physical exam upon making a fist the fingers adjacent to the injured digit will not reach full flexion grip strength decreased Imaging Radiographs usually not required Treatment Nonoperative observation indications mild symptoms not affecting quality of life Operative release FDP of injured digit indications severe symptoms limiting function
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ04.97) A 35-year-old butcher inadvertently lacerates his ring finger FDP tendon at the level of the DIP joint which is subsequently repaired. Following the operation he notes the inability to fully flex his long and small fingers at the DIP joints with attempted fist clenching as well as a weak grip. Which of the following intraoperative maneuvers was likely responsible for this? Review Topic QID: 1202 1 FDP reconstruction with a long tendon graft 4% (179/4545) 2 FDS to FDP transfer at level of the A2 pulley 2% (112/4545) 3 Inadequate repair of the C3, A4 and A5 pulleys 2% (88/4545) 4 Distal advancement of lumbricals 3% (142/4545) 5 Overtensioning of the FDP tendon 88% (4000/4545) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 5 (OBQ07.34) A butcher sustains a traumatic amputation of the ring finger through the distal interphalangeal joint. He is brought to the operating room where the flexor digitorum tendon is retrieved and advanced to the distal stump. Three months after surgery the patient notes that when he makes a fist, only his ring finger tip reaches the palm. What is this patient's clinical problem? Review Topic QID: 695 1 mallet finger 2% (50/2298) 2 swan neck deformity 1% (22/2298) 3 boutonniere deformity 1% (33/2298) 4 lumbrical plus deformity 6% (149/2298) 5 quadrigia syndrome 88% (2030/2298) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 5