Closed traumatic avulsion of both ring finger flexors with successful primary repair more than 4 weeks after injury and a review of the literature(†)

Closed flexor digitorum profundus (FDP) tendon avulsions are a recognized injury in hand surgery. However, closed tendon avulsion of both flexor tendons in the same digit is rare, with the few cases reported in the literature and presented here. Management includes primary repair ideally within the first 2 weeks to achieve optimal outcome. While beyond 4 weeks a two-stage repair is the dictum, we present a case where both tendons were avulsed but primary repair of the FDP was possible more than 4 weeks after the injury, with a good outcome. This case highlights that primary tendon repair at 32 days, the longest noted in the literature in this group of patients, can result in a good outcome even if the injury is more than 4 weeks old. However, good intraoperative decision-making is key and the skillset must be present for conversion to a two-stage repair if necessary.