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Simultaneous Closed Rupture of Flexor Digitorum Superficialis and Flexor Digitorum Profundus Tendons in the Middle Finger: A Case Report
Robert W. Jordan, MBChB, MRCS; Naeil Lotfi, K. Srinivas; Gunaratnam Shyamalan
Trauma & Orthopaedic, Birmingham Heartlands Hospital, Birmingham, United Kingdom

Closed tendon ruptures are uncommon as they represent the strongest link in the musculotendinous chain. Closed rupture of both flexor tendons of the same digit are rare and only a handful of cases have been reported in the literature. The diagnosis is clinical but can be supported by both ultrasound and magnetic resonance imaging which can provide additional information on tendon integrity, location of injury and the distance between tendon ends.

We report a case of a 20 year old left-handed man who injured his middle finger whilst playing rugby. Immediately he suffered pain but was able to complete the remainder of the game. Afterwards his finger had swollen and he was unable to bend it fully. On examination he was unable to flex the distal interphalangeal joint (DIPJ) and had very weak flexion at the proximal interphalangeal joint (PIPJ). Passive movement was maintained at the DIPJ but he had a restricted passive range of motion at the PIPJ. An initial diagnosis of a closed rupture of the FDP tendon was made.

Surgical exploration was performed and under anaesthesia tenodesis revealed no flexion at the PIPJ or DIPJ. Initially a Brunnerís incision was performed opening the A5 pulley where a rupture of the FDP tendon was identified. It was not possible to milk the retracted FDP tendon so the initial incision had to be extended proximally to the A1 pulley revealing a complete rupture of the FDS tendon. The FDS tendon was not repaired and trimmed to facilitate repair of the FDP. The FDP tendon was threaded back through the residual pulleys and finally secured to the distal phalanx using a dorsal pull through technique. The patient was splinted in the Edinburgh position and commenced on an active range of motion protected with a dorsal splint. Unprotected movement of the finger was allowed from 8 weeks. He was reviewed in the outpatient clinic at four months where he had full movement at the PIPJ and an arc of 20 degrees to 70 degrees of flexion at the DIPJ. The patient reported a DASH score of 0 and he had successfully return to work and sport.

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