CASE REPORT Comminuted fracture of distal phalanx complicated by flexor digitorum avulsion Ahmadreza Afshar * Orthopedic Department, Urmieh University of Medical Sceinces, Shahid Motahary Hospital, Kashani Street, Urmieh, West Azerbeijan, Iran Accepted 8 August 2005 Introduction Avulsion of the flexor digitorum profundus (FDP) tendon insertion is a well-known injury in athletes. There are few reports of FDPavulsion associated with a fracture. 1,2,5 I report a case of comminuted fracture of the distal phalanx complicated by FDP avulsion. Case history A 46-year-old man trapped his right ring finger while at his workplace, crushing the distal phalanx. Three days post-injury he was referred due to a very tender, swollen, bruised distal phalanx. The nail and nail bed were intact, his sensation was impaired. The diagnosis, based on physical and X- ray examination, was a comminuted fracture with soft tissue injury to the volar surface and pulp (Fig. 1). Under ring block anesthetic he was unable to flex the distal inter-phalangeal (DIP) joint. X-ray confirmed the fracture line extended to the DIP joint and the volar intra-articular fragment was displaced and comprised 50% articular surface (Fig. 2). Because of the poor condition of the soft tissues, his surgery was deferred for three weeks. By using a volar Bruner incision over the distal and middle phalanges, the fracture site was approached. The avulsed fragment was reduced and fixed with a 2 mm screw (Fig. 3). The joint surface was then checked by X-ray. The limb was immobilised in a splint with the wrist flexed 308, the metacarpophalangeal joints flexed at approximately 708, and the interphalan- geal joints maintained in extension. A dynamic rubber band was instituted on the second post- operative day and maintained for four weeks. At 6 months the range of motion of the DIP joint was 10—458, without pain. There was normal sensation and no nail deformity. Discussion Avulsion of the FDP tendon insertion has been clas- sified into three types on the basis of retraction of the FDP: type I, the tendon retracts into the palm with rupture of both vincula; type II, the tendon retracts to the level of the proximal interphalangeal joint leaving the long vinculum and its blood supply intact; type III, there is a large bony fragment retained by the tendon. This is the rarest type. 4 Smith 5 described a case in which there was unstable intra-articular fracture of the distal pha- lanx and the FDP tendon was found lying at the base Injury Extra (2006) 37, 76—77 www.elsevier.com/locate/inext * Tel.: +98 912 3131556; fax: +98 441 2234125. E-mail address: afshar@umsu.ac.ir. 1572-3461/$ — see front matter # 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2005.08.007