hjury Vol. 26, No. 8, pp. 550, 1995 Copyright 0 1995 Elsevier Science Ltd Printed in Great Britain. All rights reserved
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An unusual profundus
case of isolated laceration
flexor
digitorum
J. Th omas Department of Plastic Surgery, Leicester Royal Infirmary, Leicester, UK
Injury, Vol. 26, No. 8, 550,
1995
Introduction Isolated injuries to the flexor digitorum profundus are rare as its position meansthat adjacent structures are usually involved. A caseis describedhere.
because of the short vincular attachment. If hyperextension does occur, it means that the flexor digitorum profundus hasbeen avulsed from its insertion. This caseis reported to highlight the fact that no injury in the hand, however trivial, should be taken lightly and a meticulous examination must be conducted in all cases.
Case report A 30-year-oldright-handedmaninjuredhisnon-dominanthand whileworking with a screwdriver.He presentedto the Accident andEmergencydepartmentwith a puncturewound at the level of the metacarpal-phalangeal joint of the index finger,complaining of beingunableto bendhisindex finger ‘all the way round’. On examination,it wasfound that there wasno flexion at the distalinterphalangeal joint. All the other digitswereundamaged. At operation,the flexor digitorum profunduswasfound to be completelydivided at the level of themetacarpophalangeal joint. The flexor digitorum superficialisand the digital neurovascular bundleswere intact. Figure I showsthe characteristicpostureof the flexor digitorum profundusinjury wherethe distalinterphalangealjoint is out of alignment with the rest of the finger cascade.The intact flexor digitorum superficialisis maintaining the flexion of the proximal interphalangealjoint.
I. Distal interphalangeal joint of the index finger out of alignmentwith the restof the fingercascade in the anaesthetized hand. Figure
Discussion Anatomy textbooks’ describing the position of the flexor tendons in the palm place the flexor digitorum superficialis immediately above the flexor digitorum profundus. The neurovascular bundles run on either side of these tendons. Isolated injuries of the flexor digitorum profundus in the palm are rare. Usually they are associatedwith injury to the adjoining tendon or the neurovascular bundles.Lister’ has graphically described,the position of the digits following injury to the flexor tendons of the digits. A flail digit results when both tendons aredivided. When the flexor digitorum profundus alone is divided, there is loss of distal interphalangeal joint flexion. Hyperextension does not occur
References I Last RJ.Anatomy. Regionnl and Applied. 7th Ed. New York: ChurchillLivingstone,1986,p. 99. 2 Lister G. The Hand. Diagnosis and indications. New York: ChurchillLivingstone,1984,p. 26. Paper accepted 23 May 1995.
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