A 15-year-old Caucasian boy with no relevant medical history went to the emergency department after suffering trauma in his right hand caused by a fall forward while playing football. He presented a deformity at the base of the second finger, swelling, and painfully restricted motion. Rotational deformity of the second finger associated with radial deviation and hyperextension was found during physical examination, but neurovascular structures were intact.
The X-ray (Fig. 1) showed fracture of the proximal phalanx diaphysis of the second finger of the right hand with deviation. Closed reduction under sedation was performed applying traction and ulnar deviation followed by syndactyly and immobilization with Zimmer splint. The control X-ray (Fig. 2) revealed acceptable reduction, and the patient was referred to follow-up at the outpatient consultation. The conservative treatment was kept for 25 days, with apparent fracture healing on the X-ray (Fig. 3), but the patient presented limitation on active flexion of the finger which was interpreted as a sequel of the immobilization. Thus, he was referred for physical therapy rehabilitation. Six weeks after the initial trauma, the patient was observed at the emergency department for new right-hand trauma. On examination, no active flexion of the third phalanx of the second finger of the right hand was noticed. The X-ray didnot show any new fracture (Fig. 4). Then, the patient underwent an ultrasound that revealed deep flexor tendon entrapment at the previous fracture focus. A surgery was proposed and accepted by the legal guardians. The patient was prepared to surgery. After the Bruner incision in the palm face of the affected finger, the entrapment of the deep flexor tendon within the proximal phalanx was observed (Fig. 5). Then, tenolysis of the entrapped tendon was made (Fig. 6) enabling the visualization of the bone space created by the fracture and where the tendon was trapped (Fig. 7). After that, a reconstruction of the pulleys was performed using a portion of long palmar tendon (Fig. 8 and 9) with good immediate functional result (Video 1). The X-ray performed 2 weeks later (Fig. 10), documented a good result.
Four weeks later, the patient had good clinical evolution with almost complete recovery of mobility.