Volume 198 - Issue 4
Flexor digitorum profundus avulsion injuries in Oztag players
Authors: Mohammed Baba, Jason N Harvey, Anthony J Beard and Richard D Lawson
Med J Aust 2013; 198 (4): 196. || doi: 10.5694/mja12.11534
Published online: 4 March 2013
Published online: 4 March 2013
A common injury in a popular sport that requires early referral and management
To the Editor: Tag rugby, known in Australia as Oztag,1 is a popular low-contact version of rugby league in which an opponent is “tackled” by pulling a velcro tag off his or her shorts. The sport has over 40 000 participants in Australia1 and is perceived to pose a low risk of serious injury. However, hand injuries occur with some frequency2,3 and are often neglected. In particular, avulsion of the flexor digitorum profundus (FDP) insertion from the base of the terminal phalanx — commonly known as rugger jersey finger — may masquerade as a simple “sprain”. Failure to make the correct diagnosis early can result in serious impairment of function of the affected finger.4 Diagnosis is based on history, an examination demonstrating loss of active flexion of the distal interphalangeal joint of the affected finger, and a radiograph to assess for avulsion fractures. Ultrasound scanning can assist diagnosis in difficult cases.
From a retrospective chart review, we found that eight patients with Oztag-related FDP avulsion injuries presented to our tertiary referral hand centre over 2 years. Five patients who presented within 10 days of injury each had a primary repair with satisfactory results. The other three patients were seen 4 weeks or more after the injury. One patient seen at 4 weeks opted against a two-stage reconstruction and had excision of a painful FDP stump from the palm, with permanent loss of active distal interphalangeal joint flexion but relief of pain. The remaining two patients, seen at 6 and 8 weeks after injury, had two-stage flexor tendon reconstructions.
Early diagnosis is vital with this injury, as patients presenting late may lose the chance to have a simple primary repair. By 7–10 days after injury, unopposed muscle contraction leads to proximal retraction of the tendon stump; the pulley system tends to collapse and the sheath fills with granulation tissue. At this point, advancing the tendon is difficult or impossible, and reinsertion of the stump may result in a persistent flexion contracture; thus, reconstruction of the flexor tendon with primary or two-stage grafting may be offered. Two-stage grafting requires removal of the damaged FDP tendon and insertion of a silicone rod into the flexor sheath at the first stage, and recreation of the FDP with a tendon graft at a second stage 3 months later. Extensive physiotherapy is required, and the procedure is not always successful in achieving a return to normal function.
The treatment and ultimate function of patients with FDP avulsions is heavily influenced by the time from injury to surgery. Primary care doctors and Oztag participants should be aware that hand injuries sustained while playing the sport may be serious, and early expert evaluation is advisable.
Competing interests
No relevant disclosures.
References
- Oztag Australia [website]. http://www.oztag. com.au (accessed Nov 2012).
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- O’Keeffe ME, Conroy FJ, Kelly J, et al. Tag rugby: a safe alternative? A review of hand injuries sustained playing tag rugby (2007 season). Emerg Med J 2011; 28: 599-600. 0_i1142871
- Leddy JP, Packer JW. Avulsion of the profundus tendon insertion in athletes. J Hand Surg Am 1977; 2: 66-69. 0_i1142874