Closed rupture of the flexor digitorum profundus tendon of the little finger caused by calcification of the triangular-fibrocartilage

Closed rupture of the flexor digitorum profundus tendon of the little finger caused by calcification of the triangular-fibrocartilage

CLOSED RUPTURE OF THE FLEXOR DIGITORUM PROFUNDUS TENDON OF THE LITTLE FINGER CAUSED CALCIFICATION OF THE TRIANGULAR-FIBROCARTILAGE BY A. FUKUI, A. K...

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CLOSED RUPTURE OF THE FLEXOR DIGITORUM PROFUNDUS TENDON OF THE LITTLE FINGER CAUSED CALCIFICATION OF THE TRIANGULAR-FIBROCARTILAGE

BY

A. FUKUI, A. KIDO, Y. INADA, Y. MII and S. TAMAI From the Department of Orthopedic Surgery, Nara Medical University, Japan A case of rupture of flexor digitorum profundus tendon of the little linger caused by calcification of the triangular fibrocartilage (TFC) is reported. At operation, a round defect of the TFC and rupture of the flexor digitorum profundus tendon (FDP) of the little linger were observed. The defect of TFC was repaired using the palmaris tendon and FDP of the little linger was woven into FDP of the ring linger. Eleven months after operation, the patient had almost full flexion and extension of the distal and proximal interphalangeal joints.

Journal of Hand Surgery (British and European Volume, 1996) 2lB." 3:375-377 interphalangeal joints, and 45 + active flexion of the distal interphalangeal joint (Fig 4).

There have been many reports of closed ruptures of the deep flexor tendons. In 1960 Boyes and Wilson reported that three of 78 flexor digitorum profundus tendon (FDP) ruptures occurred at the level of the carpal tunnel. We are not aware of a previous description of rupture of the FDP of the little finger caused by calcification of the triangular fibrocartilage (TFC).

DISCUSSION Closed rupture of the little FDP is uncommon. Boyes and Wilson (1960) reported that only six of 78 FDP ruptures affected the little finger, three of 78 occurring

CASE REPORT A 74-year-old woman presented with a complaint of inability to flex the right little finger of her dominant hand at the distal interphalangeal joint. Two weeks previously she had been sweeping a garden. She had not noted hyperextension of the little finger during sweeping. There was slight tenderness distal to the wrist suggesting the site of rupture and no sensory disturbance. X-ray showed narrowing of the radiocarpal joint and calcification of TFC. There were no exostoses, bony spicules or old fractures (Fig 1). Preoperative screening for rheumatoid arthritis, gout, abnormal iron and copper metabolism showed no abnormality. Three weeks after injury, the proximal palm was explored and the intact flexor digitorum superficial tendon of the little finger was identified. The distal stump of the FDP of the little finger was found to be ruptured within the distal portion of the wrist. Beneath the tendon rupture there was a round defect located in the ulnar half of the TFC, 10 mm in diameter (Fig 2). After debriding the edge of the TFC, a 5 cm length of the palmaris longus t6ndon was harvested from the same hand and used to repair the defect in the TFC. The distal stump of FDP of the little finger was interwoven into the profundus tendon of the ring finger. An arthrogram 3 months after operation revealed that there was no communication between the radiocarpal and radioulnar joints. This indicated that the tendon graft had anatomically substituted for the TFC and that the covering of the distal ulnar joint surface was adequate (Fig 3). Eleven months after operation, the patient had full flexion of the metacarpophalangeal and proximal

Fig 1

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Preoperative X-ray. Narrowing of radiocarpal joint and calcification of triangular fibrocartilage are seen.

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Fig 2

THE J O U R N A L OF H A N D SURGERY VOL. 21B No. 3 JUNE 1996

The round defect of triangular fibrocartilage arrows) and distal stump of flexor digitorum profundus tendon have been grasped by the forceps.

Fig 4

Fig 3

Arthrogram 3 :months after operation shows that the communication between the radiocarpal and radioulnar joints has been blocked.

11 months postoperatively showing range of movement.

in the carpal tunnel. In 1972 Folmar et al reported that two out of ten F D P ruptures affected the little finger. In 1983 Berger et al took X-rays of 18 fresh, frozen cadaveric wrists after injecting renografin-60 into the radiocarpal joint. They classified three patterns of the TFC. O u r case is similar to their type III, that is the width of the defect was 5 m m and it was located at the ulnar styloid macroscopically,: so we thought it necessary to repair the defect. We believe that inflam-

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mation secondary to calcification caused the tendon rupture.

F O L M A R R C, NELSON C L and P H A L E N G S (1972). Rupture of the flexor tendons in hands of non-rheumatoid patients. Journal of Bone and Joint Surgery, 54A: 579-584.

Refelrence$ B E R G E R R A, BLAIR W F and E L - K H O U R Y G Y (1983). Arthrotomography of the wrist: the triangular fibrocartilage complex. Clinical Orthopaedics and Related Research, 172:257 264. BOYES J H and WILSON J N (I960). Flexor tendon ruptures in the forearm a n d hand. Journal of Bone and Joint Surgery, 42A: 637 646.

Accepted: 2 October 1995 Akihiro Fukui, MD, Department of Orthopedic Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara, 634 Japan. © 1996 The British Society for Surgery of the Hand