Treatment of Avulsion Fractures and Possible Flexor Tendon Avulsion of the Fifth Digit

Initial Diagnostic Workup

Obtain at least 3-view radiographs of the affected digit to properly assess fracture pattern, displacement, and articular involvement, as recommended by the American College of Radiology 1, 2
MRI is the definitive imaging modality if flexor tendon avulsion is suspected, with sensitivity of 92-100% and specificity of 100% for detecting tendon injuries, level of retraction, and associated pulley injuries, according to the American College of Radiology 3

Surgical intervention is specifically indicated when displacement >3mm is present, as suggested by Praxis Medical Insights 2
Surgical intervention is also indicated when more than one-third of articular surface is involved, as recommended by the American College of Radiology 1, 2
Interfragmentary gap >3mm exists, as suggested by Praxis Medical Insights 2

Rigid immobilization for 3-6 weeks followed by aggressive early motion is the standard protocol, with splinting protecting the repair during initial healing, as suggested by Praxis Medical Insights 2
Active finger motion exercises must begin immediately after immobilization period to prevent stiffness, which is the most functionally disabling complication, as suggested by Praxis Medical Insights 2
Home exercise programs moving fingers through complete range of motion are effective and minimize stiffness risk, as suggested by Praxis Medical Insights 2

Unremitting pain during follow-up warrants immediate reevaluation, as it may indicate inadequate fixation, as suggested by Praxis Medical Insights 2
Unremitting pain during follow-up may also indicate pulley system injury or tendon adhesions or re-rupture, as reported by the American College of Radiology 3