Unusual Closed Traumatic Avulsion of Both Flexor Tendons in Zones 1 and 3 of the Little Finger

Abstract

Closed tendon avulsion of both flexor tendons in the same finger is an extremely rare condition. We encountered the case of a patient who presented a rupture of the flexor digitorum profundus in zone 1 and flexor digitorum superficialis in zone 3 in the little finger. This occurrence has not been reported previously. We hereby present our case, make a review of the literature of avulsion of both flexor tendons of the same finger, and propose a treatment according to the site of the ruptures.

Closed Traumatic Avulsion of Both Flexor Digitorum Tendons: An Addition to the Leddy and Packer Classification and Review of the Literature

“…The use of ultrasound has been studied in the context of single flexor tendon injuries; however, its utility for multiple closed tendon injuries has yet to be established. 11,18,19 FDP avulsion injuries were classically described by Leddy and Packer 2 and included three subtypes as follows-I: a tendinous avulsion with disruption of the vinculum and retraction into the palm; II: a tendinous avulsion which retracts to the PIPJ with intact vinculum; and III: a bony avulsion injury with retraction to the A4 pulley. This classification has since been modified to include type IV 20 ; a combination of a bony avulsion and tendon avulsion with secondary tendon retraction into the finger or palm and a distal phalanx fracture incarcerated at the A4 pulley.…”

“…The use of ultrasound has been studied in the context of single flexor tendon injuries; however, its utility for multiple closed tendon injuries has yet to be established. 11 18 19…”

“…3-10 A further six cases have been reported of rupture in the midsubstance of both tendons. [11][12][13][14] We encountered an unusual case of closed avulsion of both flexor tendons of the ring finger with rupture of the FDP and FDS tendons, both from their respective sites of insertion. This is the most recent reported combination of this rare presentation.…”

“…3 4 5 6 7 8 9 10 A further six cases have been reported of rupture in the midsubstance of both tendons. 11 12 13 14…”

An Unusual Pattern of Closed Flexor Tendon Avulsion

“…Closed injuries to both flexor tendons of a digit have been described 1 but remain an uncommon injury pattern. The involvement of a significant fracture can further complicate management.…”