J Korean Orthop Assoc.  2019 Oct;54(5):447-451. 10.4055/jkoa.2019.54.5.447.

Flexor Digitorum Avulsion Secondary to Enchondroma of the Distal Phalanx

• Moon SH
• Hong CG
• Lee WS
• Park JW

• KMID: 2461235
• DOI: http://doi.org/10.4055/jkoa.2019.54.5.447

Abstract

This case report describes the unusual occurrence of a flexor digitorum profundus avulsion secondary to an enchondroma of the distal phalanx of the middle finger. The enchondroma was treated by simple curettage with an autogenous bone graft harvested from the olecranon. The avulsed bone fragment was reattached to the distal phalanx using the pull-out suture technique. Bony union and full function of the digit were achieved.

Keyword

distal phalanx; flexor digitorum profundus; enchondroma

MeSH Terms

Chondroma*
Curettage
Fingers
Olecranon Process
Suture Techniques
Transplants

Figure

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  Figure 1 Standard X-rays showing a bony fragment avulsed from an enchondroma at the base of the distal phalanx of the left middle finger. (A) Posteroanterior view. (B) Lateral view.

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  Figure 2 Post-contrast fat-suppressed T1-weighted magnetic resonance imagings show an expansile intramedullary lesion in the entire bone marrow of the distal phalanx with small dot-like enhancing foci. (A) Coronal view. (B) Sagittal view.

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  Figure 3 (A) Flexor digitorum profundus (FDP) tendon had been avulsed at its insertion. (B) After curettage and bone graft insertion, the FDP was reinserted on the grafted bone using the pull-out suture technique. (C) Immediate postoperative lateral X-ray shows the pull-out button on top of the nail plate.

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  Figure 4 Microscopic findings show scattered chondrocytes located in the lacunar spaces with abundant hyaline cartilage matrix. The nuclei are small, round and hyperchromatic (H&E, ×100).

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  Figure 5 Ten months after surgery. (A) Posteroanterior view. (B) Lateral view, showing satisfactory bony union and incorporation of bone graft. (C) Functional outcome; full flexion of the left 3rd distal interphalangeal joint is noted.

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