Mateusz Gładysz FESSH prep

FESSH prep Tendon injuries Mechanism, digit affected, the Leddy–Packer criteria and urgency by retraction level, biomechanics of anchor versus pull out repair

Closed avulsion of flexor digitorum profundus (jersey finger)

Last reviewed v1.0

FESSH-055Tendon injuries●○○ basic

Regarding closed avulsion of the flexor digitorum profundus insertion (jersey finger):

  1. 1.The injury typically results from forced extension of a finger while flexor digitorum profundus is actively contracting.

  2. 2.The ring finger is the digit most commonly affected.

  3. 3.When the tendon has retracted into the palm, it can usually be reinserted directly several months after the injury because its blood supply is preserved.

  4. 4.The original Leddy–Packer classification grades the injury by the size of the extension lag at the distal interphalangeal joint and the time since injury.

  5. 5.Pooled cadaveric data show that suture-anchor reinsertion of flexor digitorum profundus has a significantly higher ultimate load to failure than a pull-out button repair.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-055
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. The injury typically results from forced extension of a finger while flexor digitorum profundus is actively contracting.

    True

    The classic mechanism is gripping an opponent's jersey: the player's finger is actively flexing while the opponent's movement extends it passively, overloading the profundus insertion. Lim's systematic review describes closed flexor avulsions as resulting from hyperextension of a flexed finger, and Hoppe's open-access series describes the same mechanism.

    • Lim B, Seth I, Xie Y, Marcaccini G, Trignano E, Cuomo R, et al.. Double jersey finger: A systematic review and case series. JPRAS Open. 2026;49:402-418. PMID 41970316
    • Hoppe PL, Frenzel S, Krusche-Mandl I, Thalhammer G, Hajdu S, Halát G. Characteristics and Therapy of Jersey Finger Type V Injuries at a Middle-European Level 1 Trauma Center-A Retrospective Data Analysis. J Clin Med. 2024;13(21). PMID 39518678

  2. 2. The ring finger is the digit most commonly affected.

    True

    Leddy and Packer's 36 athletic avulsions were most common in the ring finger, and Bynum noted the same predominance. Bynum's laboratory work showed that during grip the ring fingertip becomes 5 mm more prominent than any other digit in 90% of subjects and absorbs more force on pull-away testing; Manske found the ring-finger insertion weaker than the middle-finger insertion in cadavers.

    • Leddy JP, Packer JW. Avulsion of the profundus tendon insertion in athletes. J Hand Surg Am. 1977;2(1):66-9. PMID 839056
    • Bynum DK, Gilbert JA. Avulsion of the flexor digitorum profundus: anatomic and biomechanical considerations. J Hand Surg Am. 1988;13(2):222-7. PMID 3351247
    • Manske PR, Lesker PA. Avulsion of the ring finger flexor digitorum profundus tendon: an experimental study. Hand. 1978;10(1):52-5. PMID 710982

  3. 3. When the tendon has retracted into the palm, it can usually be reinserted directly several months after the injury because its blood supply is preserved.

    False

    Leddy and Packer advised that a tendon retracted into the palm should be repaired within 7 days; it is the tendon that retracts only to the level of the proximal interphalangeal joint that can often be repaired a few months after injury. Their classification takes into account the status of the tendon's blood supply as well as the level of retraction.

    • Leddy JP, Packer JW. Avulsion of the profundus tendon insertion in athletes. J Hand Surg Am. 1977;2(1):66-9. PMID 839056

  4. 4. The original Leddy–Packer classification grades the injury by the size of the extension lag at the distal interphalangeal joint and the time since injury.

    False

    Leddy and Packer classified the injury into three types according to the presence or absence of a bony fragment on radiographs, the level to which the tendon retracted, and the status of its blood supply. Types IV (bony fragment with the tendon also avulsed from it) and V (associated distal phalangeal fracture) were added later, as summarised in the introduction to Hoppe's open-access series.

    • Leddy JP, Packer JW. Avulsion of the profundus tendon insertion in athletes. J Hand Surg Am. 1977;2(1):66-9. PMID 839056
    • Hoppe PL, Frenzel S, Krusche-Mandl I, Thalhammer G, Hajdu S, Halát G. Characteristics and Therapy of Jersey Finger Type V Injuries at a Middle-European Level 1 Trauma Center-A Retrospective Data Analysis. J Clin Med. 2024;13(21). PMID 39518678

  5. 5. Pooled cadaveric data show that suture-anchor reinsertion of flexor digitorum profundus has a significantly higher ultimate load to failure than a pull-out button repair.

    False

    Imbergamo's meta-analysis of 7 cadaveric studies found greater initial stiffness and less gap formation with suture anchors, but no significant difference in ultimate failure load; both repairs failed at loads significantly lower than those of the native insertion, and the analysis lacked the power to show equivalence. Clinically, no repair technique has been shown to be clearly superior.

    • Imbergamo CM, Sequeira SB, Miles MR, Means KR. A Meta-Analysis of Biomechanical Studies for Suture Button Pullout Versus Suture Anchor Repair of Flexor Digitorum Profundus Avulsions. Hand (N Y). 2022;19(4):671-678. PMID 36196928
    • Ruchelsman DE, Christoforou D, Wasserman B, Lee SK, Rettig ME. Avulsion injuries of the flexor digitorum profundus tendon. J Am Acad Orthop Surg. 2011;19(3):152-62. PMID 21368096