Avulsions of the flexor digitorum profundus tendon may involve tendon retraction into the palm and fractures of the distal phalanx. Although various repair techniques have been described, none has emerged as superior to others. Review of the literature does provide evidence-based premises for treatment: multi-strand repairs perform better, gapping may be seen with pullout suture-dorsal button repairs, and failure because of bone pullout remains a concern with suture anchor methods. Clinical prognostic factors include the extent of proximal tendon retraction, chronicity of the avulsion, and the presence and size of associated osseous fragments. Patients must be counseled appropriately regarding anticipated outcomes, the importance of postoperative rehabilitation, and potential complications. Treatment alternatives for the chronic avulsion injury remain patient-specific and include nonsurgical management, distal interphalangeal joint arthrodesis, and staged reconstruction.
From the Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA (Dr. Ruchelsman), and Hand Surgery, PC, Department of Orthopaedic Surgery, Newton-Wellesley Hospital/Tufts University School of Medicine, Newton, MA (Dr. Ruchelsman), and the Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, NY (Dr. Christoforou, Dr. Wasserman, Dr. Lee, and Dr. Rettig).
Dr. Lee or an immediate family member serves as a board member, owner, officer, or committee member of Manus Club, Inc.; has received research or institutional support from Arthrex, Integra, Mitek, SBI, and Synthes; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research-related funding (such as paid travel) from DePuy and Mitek. None of the following authors or any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Ruchelsman, Dr. Christoforou, Dr. Wasserman, and Dr. Rettig.