Management of Distal Phalanx Intraarticular Comminuted Fracture of Small Finger with Zone I Flexor Tendon Avulsion: A Case Report

Wharton Benjamin; Labor Madeline; Johnston Patrick

doi:doi:10.11648/j.ijmcr.20240302.11

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Management of Distal Phalanx Intraarticular Comminuted Fracture of Small Finger with Zone I Flexor Tendon Avulsion: A Case Report

Wharton Benjamin, Labor Madeline, Johnston Patrick^*

Published in International Journal of Medical Case Reports (Volume 3, Issue 2)

Received: 23 April 2024 Accepted: 17 May 2024 Published: 15 August 2024

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Abstract

Distal phalanx fractures are a common injury in both athletes and civilians. These fractures can differ greatly in severity and treatment indications depending on the size, location, and stability of the fracture in addition to appreciation of any bony comminution. Tendon avulsion in conjugation with a fracture complicates treatment and outcomes further. The classification system for these fractures have been well classified to include Type I, II, II, and IV with IV having subtypes. More recently, Type V has been added to the classification system. Designated as a comminuted distal phalanx fracture with flexor digitorum profundus avulsion, this Leddy-Packer type has two subgroups: namely, comminution without intra-articular involvement (Va) and comminution that includes the articular surface. We report the case of a 42-year-old female presenting with injury to the distal phalanx of the right small finger sustained after her dog ran away from her as she held the collar, exerting significant force in opposition to her flexed fingers. Upon exam and following appropriate imaging, her injury was defined as a Leddy and Packer Type Vb jersey finger injury. This was effectively treated with open reduction, internal fixation of the comminuted distal phalanx base and avulsion fragment. A notably rare injury, Leddy-Packer Type Vb distal phalanx avulsion injuries must be treated in a case-by-case basis, but open reduction internal fixation with plating proves an appropriate and effective means of repair in the correct patient.

Published in	International Journal of Medical Case Reports (Volume 3, Issue 2)
DOI	10.11648/j.ijmcr.20240302.11
Page(s)	13-17
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Avulsion Fracture, Jersey Finger, Flexor Digitorum Profundus, Leddy-Packer Type Vb

References

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[2]	Eglseder WA, Russell JM. Type IV flexor digitorum profundus avulsion. J Hand Surg Am. 1990 Sep; 15(5): 735-9. https://doi.org/10.1016/0363-5023(90)90146-i . PMID: 2229969.
[3]	Wenger DR. Avulsion of the profundus tendon insertion in football players. Arch Surg. 1973 Feb; 106(2): 145-9. https://doi.org/10.1001/archsurg.1973.01350140013006 PMID: 4686518.
[4]	Leddy JP, Packer JW. Avulsion of the profundus tendon insertion in athletes. The Journal of Hand Surgery. 1977/01/01/ 1977; 2(1): 66-69. https://doi.org/https://doi.org/10.1016/S0363-5023(77)80012-9
[5]	Manske PR, Lesker PA. Avulsion of the ring finger flexor digitorum profundus tendon: an experimental study. Hand. 1978; (1): 52-55.
[6]	Murphy BA, Mass DP. Zone I flexor tendon injuries. Hand Clin. May 2005; 21(2): 167-71. https://doi.org/10.1016/j.hcl.2004.12.004
[7]	Von Z. Trommlerlahmung Inaug. Dissertation, Berlin; 1891.
[8]	Stevens KA, Caruso JC, Fallahi AKM, Patiño JM. Flexor Tendon Lacerations. 2023 Feb 5. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29630275.
[9]	Smith JH. Avulsion of a profundus tendon with simultaneous intraarticular fracture of the distal phalanx—Case report. The Journal of Hand Surgery. 1981/11/01/1981; 6(6): 600-601. https://doi.org/10.1016/S0363-5023(81)80141-4
[10]	Al-Qattan MM. Type 5 Avulsion of the Insertion of the Flexor Digitorum Profundus Tendon. The Journal of Hand Surgery: British; European Volume. 2001/10/01/ 2001; 26(5): 427-431. https://doi.org/10.1054/jhsb.2001.0619
[11]	Compton J, Wall LB, Romans S, Goldfarb CA. Outcomes of Acute Repair Versus Nonrepair of Zone I Flexor Digitorum Profundus Tendon Injuries. J Hand Surg Am. 2023 Aug; 48(8): 832. e1-832. e6. https://doi.org/10.1016/j.jhsa.2022.02.005 Epub 2022 Apr 9. PMID: 35414448.
[12]	Geary MB, Li KK, Chadderdon RC, Gaston RG. Complications Following Transosseous Repair of Zone I Flexor Tendon Injuries. J Hand Surg Am. 2020 Dec; 45(12): 1183. e1-1183. e7. https://doi.org/10.1016/j.jhsa.2020.05.025 Epub 2020 Jul 25. PMID: 32723570.
[13]	Ruchelsman DE, Christoforou D, Wasserman B, Lee SK, Rettig ME. Avulsion injuries of the flexor digitorum profundus tendon. J Am Acad Orthop Surg. 2011 Mar; 19(3): 152-62. https://doi.org/10.5435/00124635-201103000-00004 PMID: 21368096.
[14]	Grant I, Pandya A, Mahaffey PJ. The Re-Attachment of Tendon and Ligament Avulsions. The Journal of Hand Surgery: British; European Volume. 2002/08/01/ 2002; 27(4): 337-341. https://doi.org/10.1054/jhsb.2002.0768
[15]	Reformat DD, Nores GG, Lam G, et al. Outcome Analysis of Metacarpal and Phalangeal Fixation Techniques at Bellevue Hospital. Ann Plast Surg. Oct 2018; 81(4): 407-410. https://doi.org/10.1097/sap.0000000000001581

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APA Style

Benjamin, W., Madeline, L., Patrick, J. (2024). Management of Distal Phalanx Intraarticular Comminuted Fracture of Small Finger with Zone I Flexor Tendon Avulsion: A Case Report. International Journal of Medical Case Reports, 3(2), 13-17. https://doi.org/10.11648/j.ijmcr.20240302.11

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ACS Style

Benjamin, W.; Madeline, L.; Patrick, J. Management of Distal Phalanx Intraarticular Comminuted Fracture of Small Finger with Zone I Flexor Tendon Avulsion: A Case Report. Int. J. Med. Case Rep. 2024, 3(2), 13-17. doi: 10.11648/j.ijmcr.20240302.11

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AMA Style

Benjamin W, Madeline L, Patrick J. Management of Distal Phalanx Intraarticular Comminuted Fracture of Small Finger with Zone I Flexor Tendon Avulsion: A Case Report. Int J Med Case Rep. 2024;3(2):13-17. doi: 10.11648/j.ijmcr.20240302.11

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@article{10.11648/j.ijmcr.20240302.11,
  author = {Wharton Benjamin and Labor Madeline and Johnston Patrick},
  title = {Management of Distal Phalanx Intraarticular Comminuted Fracture of Small Finger with Zone I Flexor Tendon Avulsion: A Case Report
},
  journal = {International Journal of Medical Case Reports},
  volume = {3},
  number = {2},
  pages = {13-17},
  doi = {10.11648/j.ijmcr.20240302.11},
  url = {https://doi.org/10.11648/j.ijmcr.20240302.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmcr.20240302.11},
  abstract = {Distal phalanx fractures are a common injury in both athletes and civilians. These fractures can differ greatly in severity and treatment indications depending on the size, location, and stability of the fracture in addition to appreciation of any bony comminution. Tendon avulsion in conjugation with a fracture complicates treatment and outcomes further. The classification system for these fractures have been well classified to include Type I, II, II, and IV with IV having subtypes. More recently, Type V has been added to the classification system. Designated as a comminuted distal phalanx fracture with flexor digitorum profundus avulsion, this Leddy-Packer type has two subgroups: namely, comminution without intra-articular involvement (Va) and comminution that includes the articular surface. We report the case of a 42-year-old female presenting with injury to the distal phalanx of the right small finger sustained after her dog ran away from her as she held the collar, exerting significant force in opposition to her flexed fingers. Upon exam and following appropriate imaging, her injury was defined as a Leddy and Packer Type Vb jersey finger injury. This was effectively treated with open reduction, internal fixation of the comminuted distal phalanx base and avulsion fragment. A notably rare injury, Leddy-Packer Type Vb distal phalanx avulsion injuries must be treated in a case-by-case basis, but open reduction internal fixation with plating proves an appropriate and effective means of repair in the correct patient.
},
 year = {2024}
}

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TY  - JOUR
T1  - Management of Distal Phalanx Intraarticular Comminuted Fracture of Small Finger with Zone I Flexor Tendon Avulsion: A Case Report

AU  - Wharton Benjamin
AU  - Labor Madeline
AU  - Johnston Patrick
Y1  - 2024/08/15
PY  - 2024
N1  - https://doi.org/10.11648/j.ijmcr.20240302.11
DO  - 10.11648/j.ijmcr.20240302.11
T2  - International Journal of Medical Case Reports
JF  - International Journal of Medical Case Reports
JO  - International Journal of Medical Case Reports
SP  - 13
EP  - 17
PB  - Science Publishing Group
SN  - 2994-7049
UR  - https://doi.org/10.11648/j.ijmcr.20240302.11
AB  - Distal phalanx fractures are a common injury in both athletes and civilians. These fractures can differ greatly in severity and treatment indications depending on the size, location, and stability of the fracture in addition to appreciation of any bony comminution. Tendon avulsion in conjugation with a fracture complicates treatment and outcomes further. The classification system for these fractures have been well classified to include Type I, II, II, and IV with IV having subtypes. More recently, Type V has been added to the classification system. Designated as a comminuted distal phalanx fracture with flexor digitorum profundus avulsion, this Leddy-Packer type has two subgroups: namely, comminution without intra-articular involvement (Va) and comminution that includes the articular surface. We report the case of a 42-year-old female presenting with injury to the distal phalanx of the right small finger sustained after her dog ran away from her as she held the collar, exerting significant force in opposition to her flexed fingers. Upon exam and following appropriate imaging, her injury was defined as a Leddy and Packer Type Vb jersey finger injury. This was effectively treated with open reduction, internal fixation of the comminuted distal phalanx base and avulsion fragment. A notably rare injury, Leddy-Packer Type Vb distal phalanx avulsion injuries must be treated in a case-by-case basis, but open reduction internal fixation with plating proves an appropriate and effective means of repair in the correct patient.

VL  - 3
IS  - 2
ER  -

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Author Information

Wharton Benjamin

Department of Orthopedics, The University of Colorado School of Medicine, Aurora, USA

Contact Email
Labor Madeline

Upper Extremity Surgery, Steamboat Orthopaedic and Spine Institute (SOSI), Steamboat Springs, USA; Department of Orthopedics, The University of Colorado School of Medicine, Aurora, USA

Contact Email
Johnston Patrick

Upper Extremity Surgery, Steamboat Orthopaedic and Spine Institute (SOSI), Steamboat Springs, USA; Department of Orthopedics, The University of Colorado School of Medicine, Aurora, USA

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APA Style

Benjamin, W., Madeline, L., Patrick, J. (2024). Management of Distal Phalanx Intraarticular Comminuted Fracture of Small Finger with Zone I Flexor Tendon Avulsion: A Case Report. International Journal of Medical Case Reports, 3(2), 13-17. https://doi.org/10.11648/j.ijmcr.20240302.11

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ACS Style

Benjamin, W.; Madeline, L.; Patrick, J. Management of Distal Phalanx Intraarticular Comminuted Fracture of Small Finger with Zone I Flexor Tendon Avulsion: A Case Report. Int. J. Med. Case Rep. 2024, 3(2), 13-17. doi: 10.11648/j.ijmcr.20240302.11

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AMA Style

Benjamin W, Madeline L, Patrick J. Management of Distal Phalanx Intraarticular Comminuted Fracture of Small Finger with Zone I Flexor Tendon Avulsion: A Case Report. Int J Med Case Rep. 2024;3(2):13-17. doi: 10.11648/j.ijmcr.20240302.11

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@article{10.11648/j.ijmcr.20240302.11,
  author = {Wharton Benjamin and Labor Madeline and Johnston Patrick},
  title = {Management of Distal Phalanx Intraarticular Comminuted Fracture of Small Finger with Zone I Flexor Tendon Avulsion: A Case Report
},
  journal = {International Journal of Medical Case Reports},
  volume = {3},
  number = {2},
  pages = {13-17},
  doi = {10.11648/j.ijmcr.20240302.11},
  url = {https://doi.org/10.11648/j.ijmcr.20240302.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijmcr.20240302.11},
  abstract = {Distal phalanx fractures are a common injury in both athletes and civilians. These fractures can differ greatly in severity and treatment indications depending on the size, location, and stability of the fracture in addition to appreciation of any bony comminution. Tendon avulsion in conjugation with a fracture complicates treatment and outcomes further. The classification system for these fractures have been well classified to include Type I, II, II, and IV with IV having subtypes. More recently, Type V has been added to the classification system. Designated as a comminuted distal phalanx fracture with flexor digitorum profundus avulsion, this Leddy-Packer type has two subgroups: namely, comminution without intra-articular involvement (Va) and comminution that includes the articular surface. We report the case of a 42-year-old female presenting with injury to the distal phalanx of the right small finger sustained after her dog ran away from her as she held the collar, exerting significant force in opposition to her flexed fingers. Upon exam and following appropriate imaging, her injury was defined as a Leddy and Packer Type Vb jersey finger injury. This was effectively treated with open reduction, internal fixation of the comminuted distal phalanx base and avulsion fragment. A notably rare injury, Leddy-Packer Type Vb distal phalanx avulsion injuries must be treated in a case-by-case basis, but open reduction internal fixation with plating proves an appropriate and effective means of repair in the correct patient.
},
 year = {2024}
}

Copy | Download

TY  - JOUR
T1  - Management of Distal Phalanx Intraarticular Comminuted Fracture of Small Finger with Zone I Flexor Tendon Avulsion: A Case Report

AU  - Wharton Benjamin
AU  - Labor Madeline
AU  - Johnston Patrick
Y1  - 2024/08/15
PY  - 2024
N1  - https://doi.org/10.11648/j.ijmcr.20240302.11
DO  - 10.11648/j.ijmcr.20240302.11
T2  - International Journal of Medical Case Reports
JF  - International Journal of Medical Case Reports
JO  - International Journal of Medical Case Reports
SP  - 13
EP  - 17
PB  - Science Publishing Group
SN  - 2994-7049
UR  - https://doi.org/10.11648/j.ijmcr.20240302.11
AB  - Distal phalanx fractures are a common injury in both athletes and civilians. These fractures can differ greatly in severity and treatment indications depending on the size, location, and stability of the fracture in addition to appreciation of any bony comminution. Tendon avulsion in conjugation with a fracture complicates treatment and outcomes further. The classification system for these fractures have been well classified to include Type I, II, II, and IV with IV having subtypes. More recently, Type V has been added to the classification system. Designated as a comminuted distal phalanx fracture with flexor digitorum profundus avulsion, this Leddy-Packer type has two subgroups: namely, comminution without intra-articular involvement (Va) and comminution that includes the articular surface. We report the case of a 42-year-old female presenting with injury to the distal phalanx of the right small finger sustained after her dog ran away from her as she held the collar, exerting significant force in opposition to her flexed fingers. Upon exam and following appropriate imaging, her injury was defined as a Leddy and Packer Type Vb jersey finger injury. This was effectively treated with open reduction, internal fixation of the comminuted distal phalanx base and avulsion fragment. A notably rare injury, Leddy-Packer Type Vb distal phalanx avulsion injuries must be treated in a case-by-case basis, but open reduction internal fixation with plating proves an appropriate and effective means of repair in the correct patient.

VL  - 3
IS  - 2
ER  -

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