Avulsion of the flexor digitorum tendon secondary to enchondroma of the distal phalanx

Abstract

. Avulsion of the flexor digitorum tendon secondary to enchondroma of the distal phalanx. Can J Plast Surg 2004;12(2):67-68.Flexor digitorum profundus (FDP) tendon avulsion is a common injury in sports. This is secondary to forced extension against flexor digitorum profundus contraction. However, avulsion injury of the FDP tendon secondary to an enchondroma of the distal phalanx is extremely rare. There have only been three previous reports of such an occurrence. This report describes a fourth case of an avulsion injury of the FDP tendon secondary to enchondroma of the distal phalanx of the fourth digit.Key Words: Distal phalanx; Enchondroma; FDP avulsion fracture L'avulsion du tendon fléchisseur des doigts secondaire à un chondrome de la phalange distale L'avulsion du tendon fléchisseur profond (TFP) est une blessure sportive courante, secondaire à une extension forcée à la contraction du TFP. Cependant, une lésion d'avulsion du TFP secondaire à un chondrome de la phalange distale est d'une extrême rareté. Seulement trois cas de ce genre ont été déclarés. Le présent compte rendu décrit un quatrième cas de lésion d'avulsion du TFP secondaire à un chondrome de la phalange distale de l'annulaire.A 38-year-old right-hand-dominant man, otherwise healthy, experienced severe pain in his left fourth digit after he accidentally tapped his hand on a cleat while sailing. On clinical examination, the left fourth distal interphalangeal (DIP) joint was tender and swollen with loss of active flexion. A review of the x-rays showed an avulsion fracture and a welldefined geographic lytic lesion, consistent with an enchondroma, at the base of the distal phalanx (Figure 1).One week after the initial injury, surgical exploration was initiated with an incision over the palmar aspect of the DIP joint. The fracture site was identified at the distal phalanx. The profundus tendon was attached to the avulsed fragment, which had retracted to the A4 pulley. The enchondroma was exposed and removed by curettage creating a corticocancellous bone defect. A bolster suture was used to fix the avulsed fragment to the distal phalanx (1). Pathology was sent and confirmed the diagnosis. Postoperatively, the fourth and fifth digits were kept in flexion with a dorsal splint. Physiotherapy and active exercises began at three weeks. After a four-month course of physiotherapy the patient was pain free, with 52°a ctive flexion and -10° active extension of his left fourth DIP. A review of x-rays taken five months postoperatively shows the previously avulsed articular fragment to be reduced and healed in place (Figure 2).The patient remained pain free seven months postoperatively.