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. 2017 Nov 15;1(8):e062.
doi: 10.5435/JAAOSGlobal-D-17-00062. eCollection 2017 Nov.

A Novel Cadaveric Model of the Quadriga Effect

Andrew Schannen  1 , Samuel Cohen-Tanugi  1 , Matthew Konigsberg  1 , Peter Noback  1 , Robert J Strauch  1
Affiliations

A Novel Cadaveric Model of the Quadriga Effect

Andrew Schannen et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

Introduction: The quadriga phenomenon results from excessive shortening of the flexor digitorum profundus (FDP) tendon to the middle, ring, or small finger.

Methods: Five cadaveric specimens were used to create a model for quadriga. The FDP tendons to the middle, ring, and small fingers were shortened in 5-mm increments, and the tip-to-palm (TTP) distance of adjacent fingers was recorded.

Results: Shortening of the middle finger FDP by 10 mm resulted in an average TTP distance of 6 mm in the ring finger and 5 mm in the small finger. Shortening the ring finger FDP by 10 mm produced an average TTP distance of 11 mm in the middle finger and 9 mm in the small finger. Shortening of the small finger FDP by 10 mm resulted in an average TTP distance of 14 mm in the middle finger and 10 mm in the ring finger.

Discussion: Shortening the FDP by as little as 10 mm produced a significant quadriga effect, which was more pronounced with shortening of the small and ring FDP tendons compared to the middle finger.

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Conflict of interest statement

Dr. Strauch or an immediate family member serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the American Society for Surgery of the Hand, and the Journal of Hand Surgery—American. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this chapter: Dr. Schannen, Mr. Cohen-Tanugi, Dr. Konigsberg, Dr. Noback, and Dr. Strauch.

Figures

Figure 1
Figure 1
A, Each tendon was captured using a modified Kessler suture (2.0 braided suture) just distal to the musculotendinous junction. B, Pulling of the tendons resulted in a closed fist. Repeating this procedure various times before and after experimentation served as the internal control for the quadriga effect in each specimen.
Figure 2
Figure 2
A horizontal mattress suture through the flexor digitorum profundus tendon in zone 3.
Figure 3
Figure 3
Quadriga is present in the adjacent fingers with shortening of the middle finger flexor digitorum profundus tendon.
See this image and copyright information in PMC

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