Management of Suspected Flexor Digitorum Profundus Avulsion

Diagnostic Imaging

• The American College of Radiology recommends obtaining standard 3-view radiographs (PA, lateral, and oblique) of the affected finger to detect avulsion fractures at the FDP insertion on the distal phalanx 1
• Radiographs are usually sufficient for osseous "mallet" injuries and can identify bone fragments that may require open reduction if involving >1/3 of the articular surface 1
• MRI without IV contrast is the preferred advanced imaging if clinical examination is equivocal or to assess tendon retraction level and plan surgical approach, though it is not routinely necessary when clinical diagnosis is clear 1, 2

Initial Assessment

• Assess for bony avulsion as large fracture fragments may be palpable and alter surgical planning 1