Flexor Digitorum Profundus Tendon Avulsion—Distal Phalanx (Splay Finger)

CHAPTER 112


Flexor Digitorum Profundus Tendon Avulsion—Distal Phalanx


(Splay Finger)


Presentation


The patient has injured his finger tip by falling backward and striking it on the floor or hitting it in some other way, causing sudden and forceful hyperextension at the distal interphalangeal (DIP) joint against resistance. Alternatively, this injury can befall a football player trying to tackle the ball carrier but only catching the jersey or belt with the distal phalanx of one finger (Figure 112-1). Both mechanisms can avulse the insertion of the flexor tendon on the distal phalanx. The patient may feel a pop, followed by immediate pain and swelling. The distal fingerpad becomes markedly swollen, often with ecchymosis. The patient is often unaware that he cannot flex the DIP joint.


image


Figure 112-1 Avulsion of the flexor digitorum profundus tendon.


What To Do:


image Have the patient try to close the fingers against the palm in a loose fist. All the fingers will readily flex into the palm, but the DIP joint of the injured digit is unable to bend, and the patient cannot bring the finger tip into the palm. The patient will have full range of motion of the proximal interphalangeal joint.


image Neurovascular examination reveals intact function.


image Obtain radiographs of the finger with anteroposterior and lateral views. The radiograph is usually normal, although occasionally a small avulsion fracture may be visible on the proximal volar aspect of the distal phalanx.


image Request consultation from a hand surgeon for early surgical repair. If this injury is not treated within 3 weeks, the tendon will shorten and retract into the palm.


image A protective dorsal splint (positioned for greatest comfort) incorporating the adjacent finger and extending to the mid-forearm can be applied to reduce pain and help prevent further injury.


image Provide necessary analgesia with nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen.


What Not To Do:


image Do not assume a simple sprain exists because of negative radiographs. When there is marked swelling of the distal finger pad following a grabbing injury, be mindful of the possibility of a flexor digitorum profundus avulsion.


Aug 11, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Flexor Digitorum Profundus Tendon Avulsion—Distal Phalanx (Splay Finger)
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