A Baseball Suture Technique With Single Bone Tunnel and Button Fixation for Flexor Digitorum Profundus Avulsion Repair

Flexor digitorum profundus (FDP) avulsion injuries require secure tendon fixation within the limited footprint of the distal phalanx to achieve strong tendon purchase while minimizing tendon trauma, while osseous compromise remains a surgical challenge. We propose a novel surgical technique for FDP avulsion repair using a baseball suture configuration, a single transosseous bone tunnel, and dorsal pullout button fixation. The tendon is secured with a multi-pass baseball suture technique and advanced through a single bone tunnel in the distal phalanx, thereby providing stable fixation while minimizing osseous disruption. A protective interface is interposed beneath the dorsal button to reduce pressure-related complications at the nail apparatus. This approach is designed to improve tendon purchase while reducing tendon penetrations and minimizing osseous disruption. The accompanying images are derived from a cadaveric specimen to enhance visualization of the described technique. This method represents a simple and reproducible option for FDP avulsion repair, offering potential mechanical and practical advantages. Further biomechanical and clinical studies are required to validate its effectiveness.