Orthopaedic Hand Trauma CH35

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CHAPTER 35  | Jersey Finger

Table 35.1  The Leddy and Packer Classification System

Vincular System Disrupted

Type Level of Retraction

Treatment

I

Palm

VLP and VBP

Primary tendon repair within 7–10 d Primary tendon repair within 10 d (may be delayed) Repair of fracture fragment within 8–12 wk Fix fracture first then reattach tendon within 12 wk

II

PIP and/or small volar cortical avulsion A4 pulley (entrapped large osseous fragment) Bony avulsion + tendon avulsion with variable retraction Bony avulsion + comminuted P3 fracture

VBP

III

None

IV

Variable

V

Variable

Repair within 12 wk

Abbreviations: PIP, proximal interphalangeal; VBP, vinculum brevis profundus; VLP, vinculum longus profundus.

● ● Type II injuries involve retraction of the FDP tendon to the level of the PIP joint, and there may be a small volar cortical avulsion. The VLP is preserved in this case because it arises at the level of the PIP volar plate, but the VBP is disrupted. ● ● Type III injuries are defined as FDP retraction to the level of the A4 pulley of the middle phalanx. Retraction to this level is the result of a large bony fragment avulsion. Both vincula are intact with type III injuries permitting a delay in surgical correction, if necessary. ● ● Type IV injuries are complex and defined as simultaneous osseous distal phalanx avulsion and distal phalanx fracture. ● ● Type V injuries are similar to type IV with comminution of the distal phalanx.

ACUTE MANAGEMENT

■ ■ Splinting is used as initial management prior to surgical intervention. The forearm can be included in the splint to try and limit retraction.

DEFINITIVE TREATMENT

■ ■ All cases of jersey finger in which the tendon has completely avulsed from its insertion require surgical intervention. The accepted length of time until surgery and type of procedure are dependent upon the