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Objective We encountered the case of a patient who presented with an avulsion of both flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons from their respective insertion in the ring finger. We aim to discuss the novel treatment of this injury pattern in the context of all previously encountered cases in the literature. Materials and Methods We examined the case of our patient with avulsion of both flexor tendons in the same finger and discuss the novel method of treatment in our case. Additionally, we performed a literature review of all previous reported cases and discuss the treatment modalities and outcomes associated with each. Results We have shown a novel and successful treatment technique for avulsion of both the FDP and FDS tendons. We identified twelve other cases of this injury pattern and have compared all outcomes documented. Conclusion Closed tendon avulsion of both flexor tendons in the same finger is rare. We described a case and additionally propose a modification to the flexor tendon avulsion classification to incorporate this injury pattern and aid its management.

angulation in the ulnar shaft was then exposed through a separate single incision. After osteotomy of the ulna at the site of its maximum angulation, the shaft was realigned and fixed using a 2.4 mm locking plate. The distal ulnar stump was then resected, and the excised radial head with its neck was transferred to the distal end of the realigned ulna and fixed using a 2.4 mm locking plate. The excess fibrous tissue between the carpus and the distal ulna was then carefully stripped from the ulna preserving its distal attachment and was used to reconstruct the distal radioulnar ligament to provide stability to the newly reconstructed DRUJ. Part of the deep fascia was also used to reconstruct the DRUJ capsule to reinforce joint stability. Intraoperative fluoroscopy was used to confirm the fixation of bones and to check the forearm and wrist alignment (Figure 1(c)). The internal fixation devices were removed after complete bone union was confirmed on radiographs at 1 year (Figure 1(d)). At 1-year follow up, the elbow range of movements were from 0 extension to 130 flexion (Figure S5), the wrist extension and flexion were 85 each, and the forearm rotation was 90 of supination and 85 of pronation (Figure S6). The Patient-Rated Wrist Evaluation score and the quick Disabilities of the Arm, Shoulder and Hand score were 0.The treatment of ulnar dysplasia with radial head autograft to restore DRUJ has not been previously reported. Surgical techniques to treat ulnar dysplasia includes excision of an ulnar anlage (Flatt, 1977;Goldbach et al., 2019), creation of a one bone forearm (Straub, 1965), excision of the dislocated radial head (Goldbach et al., 2019) or lengthening of the ulna using an external fixator (Kazuki et al., 2005). Most authors agree that the ulnar anlage should be excised to prevent further radial bowing and shortening. This anlage does not seem to grow and can act as a tether to deform the radius and carpus with subsequent bowing of the radial shaft and dislocation of the radial head (Goldbach et al., 2019;Straub, 1965). Compared with the previously reported treatment options, our surgery achieved better functional outcome. Although the radial head is roughly similar in shape to the ulnar head, there are anatomical differences that would preclude the restored DRUJ from being a perfectly matched joint. At 3-year follow-up, the elbow and wrist appear to be functioning well in this patient, however it is difficult to know if degenerative arthritis or other complications will develop over a much longer period.

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Case Report Closed tendon avulsion of both flexor tendons (Flexor Digitorum profundus [FDP] and Flexor Digitorum superficialais [FDS]) in the same finger is an extremely rare condition. We are proposing this subtype of injury be added as a type VI to the current Leddy and Packer classification for FDP avulsion injuries. The objective of this being an increase in awareness to avoid misdiagnosis and to aid in the subsequent management if encountered. We present the case of a 27-year-old male who presented with an avulsion of both flexor tendons from their respective insertions in the ring finger following a sporting injury causing hyperextension against an actively flexed distal interphalangeal joint. This condition has previously been reported twelve times in the literature. We propose a novel treatment method not described for previous cases and examine the successful method of treatment in this case.