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Flexor Digitorum Profundus Avulsion Injuries

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Sports Injuries of the Hand and Wrist

Part of the book series: In Clinical Practice ((ICP))

Abstract

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.

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Author information

Authors and Affiliations

  1. Division of Plastic Surgery and Orthopedic Surgery, Toronto Western Hospital, Toronto, ON, Canada

    Heather L. Baltzer

  2. Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA

    Steven L. Moran

Authors
  1. Heather L. Baltzer
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  2. Steven L. Moran
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Corresponding author

Correspondence to Steven L. Moran .

Editor information

Editors and Affiliations

  1. Upper Limb Unit, Wrightington Hospital, Wigan, UK

    Mike Hayton

  2. Upper Limb Unit, Wrightington Hospital, Wigan, UK

    Chye Yew Ng

  3. Upper Limb Unit, Wrightington Hospital, Wigan, UK

    Lennard Funk

  4. Upper Limb Unit, Wrightington Hospital, Wigan, UK

    Adam Watts

  5. Upper Limb Unit, Wrightington Hospital, Wigan, UK

    Mike Walton

Questions and Answers

Questions and Answers

  1. 1.

    What is the mechanism of injury for flexor digitorum profundus avulsion injuries?

    Answer: Forced extension of a maximally flexed finger

  2. 2.

    Describe the five types of FDP avulsion injuries as classified by the Leddy-Packer system.

    Answer:

    I: Avulsion of FDP from distal phalanx with disruption of all vincula and retraction into the palm.

    II: Avulsion of FDP from distal phalanx with disruption of VBP and retraction to the level of the PIP joint.

    III: Avulsion of the FDP attached to a large bony fragment from the distal phalanx; retraction to the A4 pulley; all vincula intact.

    IV: Avulsion of the FDP with a large bony fragment from the distal phalanx; bony fragment remains at the A4 pulley, and the tendon retracts to the PIP joint or into the palm.

    V: FDP bony avulsion injuries with concomitant distal phalanx fractures.

  3. 3.

    What is the optimal timeframe for referral and treatment of these injuries?

    Answer: Within the first week of injury

  4. 4.

    What imaging modalities are employed for diagnosing these injuries and determining the level of tendon retraction?

    Answer:

    Plain radiographs: Determine the presence of a bony fragment. If the fragment is small and remains attached to the avulsed tendon, it can help to identify the level of retraction.

    Ultrasound and MRI can identify the level of tendon retraction.

  5. 5.

    What are the prognostic indicators for this type of injury?

    Answer: The severity of injury, the injury-to-treatment time interval, the quality of the repair, and the patient compliance with postoperative therapy protocols

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Baltzer, H.L., Moran, S.L. (2019). Flexor Digitorum Profundus Avulsion Injuries. In: Hayton, M., Ng, C., Funk, L., Watts, A., Walton, M. (eds) Sports Injuries of the Hand and Wrist. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-02134-4_2

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  • DOI: https://doi.org/10.1007/978-3-030-02134-4_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-02133-7

  • Online ISBN: 978-3-030-02134-4

  • eBook Packages: MedicineMedicine (R0)

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