Introduction Refers to an avulsion injury of FDP from insertion at base of distal phalanx a Zone I flexor tendon injury Epidemiology ring finger involved in 75% of cases during grip ring fingertip is 5 mm more prominent than other digits in ~90% of patients therefore ring finger exposed to greater average force than other fingers during pull-away Pathophysiology FDP muscle belly in maximal contraction during forceful DIP extension Anatomy Muscles Flexor Digitorum Profundus (ulnar n. and AIN n.) Flexor zones zone I extends from insertion of FDS distally Classification Leddy and Packer classification(based on level of tendon retraction and presence of fracture) Type Description Treatment Images Type I FDP tendon retracted to palm. Leads to disruption of the vascular supply Prompt surgical treatment within 7 to 10 days Type II FDP retracts to level of PIP joint Attempt to repair within several weeks for opitmal outcome Type III Large avulsion fracture limits retraction to the level of the DIP joint Attempt to repair within several weeks for opitmal outcome Type IV Osseous fragment and simultaneous avulsion of the tendon from the fracture fragment ("Double avulsion” with subsequent retraction of the tendon usually into palm) If tendon separated from fracture fragment, first fix fracture via ORIF then reattach tendon as for Type I/II injuries Type V Ruptured tendon with bone avulsion with bony comminution of the remaining distal phalanx (Va, extraarticular; Vb, intra-articular) Presentation Physical exam pain and tenderness over volar distal finger finger lies in slight extension relative to other fingers in resting position no active flexion of DIP may be able to palpate flexor tendon retracted proximally along flexor sheath Imaging Radiograhs may see avulsion fragement Treatment Operative direct tendon repair or tendon reinsertion with dorsal button indications acute injury (< 3 weeks) technique advancement of > 1 cm carries risk of a DIP flexion contracture or quadrigia postoperative rehab should include either early patient assisted passive ROM (Duran) or dynamic splint-assisted passive ROM (Kleinert) ORIF fracture fragment indications types III and IV (for type IV then repair as for Type I/II injuries) techniques with K-wire, mini frag screw or pull out wire examine for symmetric cascade once fixation completed two stage flexor tendon grafting indications chronic injury (> 3 months) in patient with full PROM of the DIP joint DIP arthrodesis indicated as salvage procedure in chronic injury (> 3 months) with chronic stiffness Complications Quadrigia advancement of > 1 cm carries risk of a DIP flexion contracture or quadrigia
QUESTIONS 1 of 3 1 2 3 Previous Next This is an AAOS Self assessment question. Orthobullets was not involved into the editorial process, and does not have the ability to alter. If you prefer to hide SAE questions on topics simply turn them off in your Content Settings (SAE07SM.93) An 18-year-old rugby player has had pain in his ring finger after missing a tackle 1 week ago. Examination reveals tenderness in the distal palm, and he is unable to actively flex the distal interphalangeal (DIP) joint. Radiographs are normal. What is the most appropriate management? Review Topic QID: 8755 1 Acute tendon repair 76% (131/173) 2 DIP joint extension splinting for 6 weeks 9% (15/173) 3 DIP and proximal interphalangeal joint extension splinting for 6 weeks 8% (14/173) 4 Buddy taping to the middle finger for 2 weeks 3% (6/173) 5 Early range-of-motion exercises and return to play as pain permits 3% (6/173) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (OBQ06.52) A 22-year-old rugby player presents with a mass at the base of his ring finger 5 months after sustaining an injury while making a tackle. Physical examination demonstrates a lack of active distal interphalangeal joint flexion, but full passive range of motion of all joints of the ring finger. Radiographs are normal. What is the most appropriate treatment to regain normal finger function? Review Topic QID: 163 1 excision of the palmar mass and 2-stage tendon grafting 70% (2009/2888) 2 excision of the palmar mass and single stage tendon grafting 14% (406/2888) 3 excision of the palmar mass and distal interphalangeal joint fusion 5% (151/2888) 4 active silicone rod implantation 3% (75/2888) 5 flexor digitorum profundis repair 8% (233/2888) ML 2 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (OBQ05.246) A 16-year-old football player sustains an injury to his ring finger after making a tackle. A clinical photograph is shown in Figure A. What is the most likely diagnosis? Review Topic QID: 1132 FIGURES: A 1 Flexor digitorum superficialis avulsion 4% (171/4352) 2 Central slip rupture 2% (83/4352) 3 Sagittal band rupture 1% (55/4352) 4 Distal extensor tendon rupture 2% (71/4352) 5 Flexor digitorum profundus avulsion 91% (3953/4352) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 5
Upgrade to View Premium Videos Upgrade to View Premium Videos Diagnositc Ultrasound of the Hand - Introduction - Dr. Scott Pollock Derek Moore General - Jersey Finger 2/9/2013 505 views