Flexor Digitorum Profundus Avulsion Injuries

  • Heather L. Baltzer
  • Steven L. MoranEmail author
Part of the In Clinical Practice book series (ICP)


FDP avulsion injuries are a type of Zone I flexor tendon injury, leaving patients unable to flex the distal interphalangeal joint. Patients with untreated injuries may experience weakened grip strength or DIP joint instability. These injuries are classified by the Leddy-Packer system, which is based on the presence and extent of bony involvement of the distal phalanx and the level of retraction of the avulsed tendon. All FDP avulsion injuries should receive early referral to a hand surgeon to facilitate prompt surgical reconstruction. Delayed initial management may prevent primary repair or decrease the likelihood of an optimal postoperative outcome. In addition to early referral and treatment, rehabilitation and therapist-directed mobilization programs are critical for optimizing outcomes. It is important to explain to patients the potential complication of stiffness and limited range of motion at the interphalangeal joints. For these injuries, patient and surgeon shared decision-making is necessary to determine the most appropriate treatment plan.


Flexor digitorum profundus avulsion injury Jersey finger Leddy-Packer classification Zone I flexor tendon injury Flexor tendon reconstruction 


  1. 1.
    Leddy JP, Packer JW. Avulsion of the profundus tendon insertion in athletes. J Hand Surg Am. 1977;2(1):66–9.CrossRefGoogle Scholar
  2. 2.
    Botte MJ, Doyle JR. Surgical anatomy of the hand and upper extremity: Lippincott Williams & Wilkins; 2003.Google Scholar
  3. 3.
    Ruchelsman DE, Christoforou D, Wasserman B, Lee SK, Rettig ME. Avulsion injuries of the flexor digitorum profundus tendon. J Am Acad Orthop Surg. 2011;19(3):152–62.CrossRefGoogle Scholar
  4. 4.
    Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SH, Cohen MS. Green’s operative hand surgery: expert consult: online and print: Elsevier Health Sciences; 2010.Google Scholar
  5. 5.
    Leversedge FJ, Ditsios K, Goldfarb CA, Silva MJ, Gelberman RH, Boyer MI. Vascular anatomy of the human flexor digitorum profundus tendon insertion. J Hand Surg Am. 2002;27(5):806–12.CrossRefGoogle Scholar
  6. 6.
    McMaster PE. Tendon and muscle ruptures. J Bone Joint Surg. 1933;15:705–22.Google Scholar
  7. 7.
    Manske PR, Lesker PA. Avulsion of the ring finger flexor digitorum profundus tendon: an experimental study. Hand. 1978;10(1):52–5.CrossRefGoogle Scholar
  8. 8.
    Bynum DK Jr, Gilbert JA. Avulsion of the flexor digitorum profundus: anatomic and biomechanical considerations. J Hand Surg Am. 1988;13(2):222–7.CrossRefGoogle Scholar
  9. 9.
    Lubahn JD, Hood JM. Fractures of the distal interphalangeal joint. Clin Orthop Relat Res. 1996;327:12–20.CrossRefGoogle Scholar
  10. 10.
    Ehlert KJ, Gould JS, Black KP. A simultaneous distal phalanx avulsion fracture with profundus tendon avulsion. A case report and review of the literature. Clin Orthop Relat Res. 1992;(283):265–9.Google Scholar
  11. 11.
    Langa V, Posner MA. Unusual rupture of a flexor profundus tendon. J Hand Surg Am. 1986;11(2):227–9.CrossRefGoogle Scholar
  12. 12.
    Mouille P, Cheymol G. Cardiovascular and hemodynamic effects of derivatives of metoclopramide. Arch Int Pharmacodyn Ther. 1975;215(1):139–49.PubMedGoogle Scholar
  13. 13.
    Smith JH Jr. Avulsion of a profundus tendon with simultaneous intraarticular fracture of the distal phalanx – case report. J Hand Surg Am. 1981;6(6):600–1.CrossRefGoogle Scholar
  14. 14.
    Stamos BD, Leddy JP. Closed flexor tendon disruption in athletes. Hand Clin. 2000;16(3):359–65.PubMedGoogle Scholar
  15. 15.
    Drape JL, Tardif-Chastenet de Gery S, Silbermann-Hoffman O, et al. Closed ruptures of the flexor digitorum tendons: MRI evaluation. Skelet Radiol. 1998;27(11):617–24.CrossRefGoogle Scholar
  16. 16.
    Cohen SB, Chhabra AB, Anderson MW, Pannunzio ME. Use of ultrasound in determining treatment for avulsion of the flexor digitorum profundus (rugger Jersey finger): a case report. Am J Orthop (Belle Mead NJ). 2004;33(11):546–9.Google Scholar
  17. 17.
    Leddy JP. Avulsions of the flexor digitorum profundus. Hand Clin. 1985;1(1):77–83.PubMedGoogle Scholar
  18. 18.
    Murphy BA, Mass DP. Zone I flexor tendon injuries. Hand Clin. 2005;21(2):167–71.CrossRefGoogle Scholar
  19. 19.
    Berger RA, Weiss AC. Hand surgery. Philadelphia: Lippincott Williams & Wilkins; 2004. p. 679–98.Google Scholar
  20. 20.
    Bruner JM. Optimum skin incisions for the surgical relief of stenosing tenosynovitis in the hand. Plast Reconstr Surg. 1966;38(3):197–201.CrossRefGoogle Scholar
  21. 21.
    McCallister WV, Ambrose HC, Katolik LI, Trumble TE. Comparison of pullout button versus suture anchor for zone I flexor tendon repair. J Hand Surg Am. 2006;31(2):246–51.CrossRefGoogle Scholar
  22. 22.
    Moiemen NS, Elliot D. Primary flexor tendon repair in zone 1. J Hand Surg Br. 2000;25(1):78–84.CrossRefGoogle Scholar
  23. 23.
    Shabat S, Sagiv P, Stern A, Nyska M. Avulsion fracture of the flexor digitorum profundus tendon (‘Jersey finger’) type III. Arch Orthop Trauma Surg. 2002;122(3):182–3.CrossRefGoogle Scholar
  24. 24.
    Kang N, Pratt A, Burr N. Miniplate fixation for avulsion injuries of the flexor digitorum profundus insertion. J Hand Surg Br. 2003;28(4):363–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of Plastic Surgery and Orthopedic SurgeryToronto Western HospitalTorontoCanada
  2. 2.Department of Orthopaedic SurgeryMayo ClinicRochesterUSA

Personalised recommendations