Interposition Tendon Graft and Tension in the Repair of Closed Rupture of the Flexor Digitorum Profundus in Zone III or IV

We report the case of a patient who fully recovered from a closed flexor tendon rupture through a two-stage flexor tendon reconstruction using silicone rods, despite a considerable delay in treatment. A 17-year-old male patient visited our clinic with a sudden inability to flex his left index finger, although there were no signs of injury. Magnetic resonance imaging revealed an extensive rupture of the flexor digitorum profundus from the base of the distal phalanx to the proximal phalangeal joint of his left hand. After a two-stage tendon graft operation was performed, the patient regained full flexion of the index finger and was able to hold a fist without any limitations in range of motion. Complete rupture of tendons usually accompanies history of trauma or underlying tendon pathology. In our case, however, the tendon rupture occurred silently with no obvious underlying causes. It is important to recognize the signs to evaluate the underlying structures for appropriate management and treatment. Even with considerable delay, the patient may regain full function of the tendon.

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Closed rupture of flexor digitorum profundus in zone III

BMJ Case Reports ◽

10.1136/bcr-2020-234393 ◽

2020 ◽

Vol 13 (4) ◽

pp. e234393

Author(s):

Ryan James Bickley ◽

James Banks Deal ◽

Ryan Luke Frazier ◽

William Etzler Daner

Keyword(s):

Flexor Digitorum Profundus ◽

Rare Injury ◽

Closed Rupture ◽

Active Flexion ◽

High Clinical Suspicion ◽

Distal Interphalangeal ◽

Distal Aspect ◽

Flexor Digitorum ◽

Jersey Finger ◽

Potential Use

Closed ruptures of the flexor digitorum profundus (FDP) tendon cause a loss of active flexion at the distal interphalangeal joint. Commonly referred to as a ‘jersey finger’ because of its association with tackling sports, the distal aspect of FDP is avulsed from its insertion on the distal phalanx in zone I, with or without a fragment of bone. Because of this classic injury mechanism and pattern, providers may not seek advanced imaging beyond plain radiographs. Although rare, injury to FDP more proximally may occur. More often this injury is associated with a weak underlying tendon because of repetitive microtrauma or anomalous anatomy, for example. We present a case of a closed rupture of the FDP in zone III, and stress the importance of maintaining a high clinical suspicion and the potential use of adjunct ultrasound imaging to localise the site of injury.

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Closed rupture of the flexor digitorum profundus tendon of little finger: A case report

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699038 ◽

2004 ◽

Vol 37 (01) ◽

pp. 67-70

Author(s):

Pawan Agarwal

Keyword(s):

Steroid Injection ◽

Flexor Digitorum Profundus ◽

Cystic Degeneration ◽

Closed Rupture ◽

Frequent Site ◽

Local Steroid Injection ◽

Flexor Digitorum ◽

Flexor Digitorum Profundus Tendon ◽

Underlying Pathology ◽

Little Finger

ABSTRACTClosed rupture of the FDP tendon is rare. However, whenever they occur the most common site of rupture is the tendon-bone insertion, less frequent site is at the musculo-tendinous junction. Midsubstance ruptures are even more unique and are usually due to underlying pathology such as fracture, cystic degeneration, rheumatoid arthritis, or sequel following local steroid injection. This report describes a closed rupture of FDP tendon of little finger. Mechanism of injury, diagnosis and management are discussed.

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Closed Rupture of the Flexor Digitorum Profundus Tendon within the Carpal Tunnel

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90164-3 ◽

1994 ◽

Vol 19 (2) ◽

pp. 197-198 ◽

Cited By ~ 7

Author(s):

K. NAKAMICHI ◽

S. TACHIBANA

Keyword(s):

Carpal Tunnel ◽

Flexor Digitorum Profundus ◽

Closed Rupture ◽

Flexor Digitorum ◽

Flexor Digitorum Profundus Tendon ◽

Underlying Pathology ◽

Little Finger

We report a case of a closed rupture within the carpal tunnel of the flexor digitorum profundus tendon of the little finger. There was no underlying pathology.

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Closed Rupture of the Flexor Digitorum Profundus Tendon of the Little Finger Caused by Calcification of the Triangular-Fibrocartilage

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(05)80207-4 ◽

1996 ◽

Vol 21 (3) ◽

pp. 375-377 ◽

Cited By ~ 6

Author(s):

A. FUKUI ◽

A. KIDO ◽

Y. INADA ◽

Y. MII ◽

S. TAMAI

Keyword(s):

Ring Finger ◽

Flexor Digitorum Profundus ◽

Closed Rupture ◽

Triangular Fibrocartilage ◽

Full Flexion ◽

Flexor Digitorum ◽

Flexor Digitorum Profundus Tendon ◽

Flexion And Extension ◽

Little Finger

A case of rupture of flexor digitorum profundus tendon of the little finger caused by calcification of the triangular fibrocartilage (TFC) is reported. At operation, a round defect of the TFC and rupture of the flexor digitorum profundus tendon (FDP) of the little finger were observed. The defect of TFC was repaired using the palmaris tendon and FDP of the little finger was woven into FDP of the ring finger. Eleven months after operation, the patient had almost full flexion and extension of the distal and proximal interphalangeal joints.

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FLEXOR DIGITORUM PROFUNDUS TENDON RUPTURE ASSOCIATED WITH DISTAL RADIUS FRACTURE MALUNION: A CASE REPORT

Hand Surgery ◽

10.1142/s0218810409004190 ◽

2009 ◽

Vol 14 (01) ◽

pp. 35-38 ◽

Cited By ~ 6

Author(s):

Takayuki Ishii ◽

Masayoshi Ikeda ◽

Yuka Kobayashi ◽

Joji Mochida ◽

Yoshinori Oka

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Tendon Rupture ◽

Flexor Tendon ◽

Corrective Osteotomy ◽

Tendon Graft ◽

Radius Fracture ◽

Flexor Digitorum Profundus ◽

Flexor Tendon Rupture ◽

Flexor Digitorum

We present a case of subcutaneous flexor tendon rupture of the index finger following malunion of a distal radius fracture. The cause of the tendon rupture was mechanical attrition due to a bony prominence at the palmar joint rim in the distal radius due to malunion. Corrective osteotomy and the Sauvé-Kapandji procedure were carried out for the wrist pain and forearm rotation disability and a tendon graft was carried out for the flexor tendon rupture. Recovery was satisfactory.

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Intrasynovial Tendon Graft for Chronic Flexor Tendon Laceration of the Finger: A Case Report

The Open Orthopaedics Journal ◽

10.2174/1874325001307010282 ◽

2013 ◽

Vol 7 (1) ◽

pp. 282-285 ◽

Cited By ~ 1

Author(s):

Jun Sasaki ◽

Toshiro Itsubo ◽

Koichi Nakamura ◽

Masanori Hayashi ◽

Shigeharu Uchiyama ◽

...

Keyword(s):

Flexor Tendon ◽

Ring Finger ◽

Tendon Graft ◽

Normal Function ◽

Flexor Digitorum Profundus ◽

Postoperative Function ◽

A2 Pulley ◽

The Right ◽

Flexor Digitorum ◽

Tendon Laceration

We present the case of a patient with flexor digitorum profundus tendon laceration at the A2 pulley level caused by an injury to the base of the right ring finger by a knife. The patient was treated by flexor tendon reconstruction from the palm to the fingertip by using the left second toe flexor tendon as a graft, which improved the active range of motion. Further improvement was achieved by subsequent tenolysis, which eventually restored nearly normal function. Our experience with this case indicates that the intrasynovial tendon is a reasonable graft source for the synovial space in fingers and may enable restoration of excellent postoperative function.

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