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Five cases with an avulsion fracture of the thumb metacarpophalangeal joint treated by a simple method of internal fixation are described. This method is designed as a form of modified tension band wiring using the combination of a single Kirschner wire and a pull-out wire, and is technically easy.

We report on the case of a 14-year-old patient with bilateral avulsion of flexor digitorum profundus (FDP) in both ring fingers. This was noted four days after a basketball match. At surgical exploration both FDP were ruptured with the ends located at A2 and A3 pulleys. These were repaired with excellent functional results. While FDP avulsions can often occur affecting the ring finger this is the first reported case of a patient presenting with a bilateral injury affecting the ring finger on both sides.

Extensor Carpi Radialis Longus (ECRL) avulsion is a rare injury which follows resisted wrist hyperflexion. Treatment of this condition with open reduction and internal fixation is not previously described in the literature, and treatment with plaster immobilisation or k-wire fixation requires a prolonged period of immobilisation. We believe that open reduction and internal fixation of these fractures with early mobilisation will result in the best possible wrist function. We describe a sign to raise the index of suspicion for this injury: a palpable bone lump on the dorsum of the hand in the presence of wrist extensor pain or weakness after wrist hyperflexion injury is a sign of wrist extensor avulsion.

We report a case of avulsion of the flexor digitorum profundus secondary to recurrent enchondroma. The tumor was curetted with bone grafting of cancellous bone from the distal radius, and the fragment avulsed by the flexor digitorum profundus tendon was fixed to its original site using a pullout suture through the distal phalanx to the nail. The lesion healed and function recovered 6 years after surgery.

The "button over the nail" is the most commonly used technique in order to re-insert the flexor digitorum profundus tendon into the distal phalanx in the management of Zone 1 injuries. Recent evidence in the literature has highlighted an associated morbidity with the technique. In this study, 37 patients were identified that had been treated using the "button technique", for which outcome data is collected by hand therapists as part of a prospective flexor tendon injury audit. Retrospective case note review was performed to determine incidence of post-operative surgical complications.

There were limited complications with the use of the "button technique" overall. However, functional outcome when compared to other studies are relatively poor with mean range of motion at the distal interphalangeal joint being 37.5 degrees. The authors would recommend any decision to change technique for the management of these injuries should consider functional outcome in the presence of a low surgical complication rate.

Closed avulsion of the flexor digitorum profundus (FDP) tendon is classified based on the impact of injury on the management plan. In this report, we present a case with unclassified pattern of FDP tendon avulsion. The injury involves an intra-articular fracture of the volar part of distal phalanx of the little finger resulting into two bony fragments, one attached to the retracted avulsed tendon and another separated and incarcerated at A4 pulley, and an intact dorsal cortex of the phalanx. Based on that, we recommend the development of a new classification scheme for this condition.

Background: Closed avulsion injury of the flexor digitorum profundus (FDP) tendon is a relatively common condition of the hand. Its present classification system seems to be deficient in including all possible patterns of injury, leading to improper selection of the best treatment method for the injury. We aim to provide a new classification scheme for this injury.

Methods: We developed a new classification scheme based on the possible pattern of FDP tendon injury. It consisted of three main types, and 10 sub-types. This was used to classify the injury of 34 patients, and help in choosing the best management approach. All patients underwent surgical treatment of their injury. The distal interphalangeal (DIP) joint extension deficit and total active motion (TAM) of the proximal interphalangeal (PIP) and DIP joints were considered as the main outcomes. Five orthopaedic surgeons used the new classification system for our cases, and the inter-rater reproducibility was tested with Fleiss' kappa.

Results: The multi-rater kappa for the classification was excellent. At the final follow-up visit 24 months following surgery, the mean loss of extension of the DIP joint was 13.76° ± 13.53° (range 0° to 45°), while the mean TAM was 148.88° ± 22.64° (range 94° to 172°). Based on the TAM score, 21 (61.76%), 8 (23.53%) and 5 (14.71%) patients had excellent, good and fair results, respectively. None of our patients had poor results.

Conclusions: Our new classification scheme of FDP tendon avulsion appeared to be comprehensive and useful in guiding the surgeon for the best treatment option. Nevertheless, this should be confirmed by using it for larger number of patients with different patterns of injury.

Combined simultaneous radial wrist extensor injuries, namely ipsilateral extensor carpi radialis longus (ECRL) and brevis (ECRB) avulsion fractures, are rare. While non-operative management with cast immobilization has been described, most recommend operative intervention in the acute setting. Surgical repair of chronic injuries, however, has received little attention in the literature. This case describes a 50-year-old male who sustained combined ipsilateral ECRL and ECRB avulsion fractures from the bases of the index and middle metacarpals. Five months after the initial trauma, he underwent surgical repair with lengthening of the tendons using a novel technique and suture anchor fixation. This case demonstrates that successful repair of this rare injury can be achieved with retracted extensor tendons in the chronic setting.