Vol. 8, No . 3 May 1983
Osteocartilaginous lesions of the digits in children
9. Curtis FE: In: Proceedings of the fifteenth Annual Meeting of the Clinical Orthopaedic Society. J Bone Joint Surg [Am] 45:1785, 1963 10. Nathan PA, Fowler A: Remodeling of a metacarpal bone graft in a child . J Bone Joint Surg [Am] 58:719-722, 1976
11. Heiple KG: Carpal osteochondroma. J Bone Joint Surg [Am] 43:861-864, 1961 12. Geschickter CF: The roentgenologic diagnosis of bone tumors. Radiology 16: 118, 1931
Avulsion of flexor profundus, secondary to enchondroma of the distal phalanx A vulsion injury of the profundus tendon secondary to enchondroma of the distal phalanx is extremely rare. A case is described in which the enchondroma cavity was filled with an iliac bone graft and the avulsed fragment attached to the bone graft and the distal phalanx with a bone screw. Full function of the digit was regained. (J HAND SURG 8:315-16, 1983.)
Olayinka Ogunro, M.D., Duncanville, Tex.
Received for publication Feb . 23, 1982. Reprint requests: Olayinka Ogunro, M.D., 777 East Wheatland Rd., Duncanville, TX 75116.
Avulsion injuries of the profundus tendon at its insertion have been reviewed extensively in the literature. I - 5 However, avulsion injury of the pro-
Fig. 1. Avulsion fracture of the distal phalanx of the ring finger secondary to enchondroma. A, Posteroanterior view. B, Lateral view. THE JOURNAL OF HAND SURGERY
315
316
The Journal of HAND SURGERY
Ogunro
Fig. 2. Small piece of iliac bone impacted into space fonned after curettage. A, Minifragment screw has been passed through the profundus thereby securing the articular fragment onto the bone graft. B, Six months after reattachment.
fundus tendon secondary to enchondroma of the distal phalanx is extremely rare. Case report A 33-year-old man was using a chain saw and as he pulled the starting cord and released it, he experienced severe pain at the tip of the right ring finger. Clinical evaluation revealed swelling and extreme tenderness on the palmar surface of the distal interphalangeal joint of the right ring finger, with inability to flex the joint. Roentgenograms revealed an enchondroma, (Fig. 1, A and B) and an avulsion fracture of the base of the distal phalanx. Surgical exploration showed the profundus tendon to be attached to the avulsed fragment. We feel the large size of the fragment prevented retraction and we observed that the fractured fragment contained a significant part of the articular surface of the distal phalanx. The enchondroma cavity was curetted and a small iliac bone graft wedged into the space. A minifragment screw was used to fix the avulsed fragment to the bone graft and the distal phalanx (Fig. 2, A) .
The bone healed satisfactorily and the screw was removed under local anesthesia 6 months later (Fig . 2, B). The patient regained full function of the ring finger. Two years after injury the patient was asymptomatic and the fingernail was nonnal. REFERENCES 1. Leddy JP, Packer JW: Avulsion of the profundus tendon
insertion in athletes . J HAND SURG 2:66, 1977 2. Carroll RE. Match RM: Avulsion of the profundus tendon insertion. J Trauma 10:1109, 1979 3. Chang WH, Thomas OJ, White WL: Avulsion injury of the long flexor tendons. Plast Reconstr Surg 15:705, 1933 4. Smith JH: Avulsion of a profundus tendon with simultaneous intraarticular fracture of the distal phalanx-Case report. J HAND SURG 6:600, 1981 5. Wenger DR: Avulsion of the profundus tendon insertion in football players . Arch Surg 106: 145 , 1973