The Leddy and Packer classification of jersey finger injuries, which is an avulsion injury of the flexor digitorum profundus (FDP) from its insertion at the base of the distal phalanx, is based on the level of tendon retraction and presence of fracture 2,3.
Classification
Leddy and Packer classification modified with the addition of a fourth type proposed by Robins and Dobyns and a fifth type by Al-Qattan 1-3:
type I: FDP tendon is avulsed without fracture and retracted to the palm
type II: FDP retracts to the level of the proximal interphalangeal joint
type III: large avulsion fracture limits retraction to the level of the distal interphalangeal (DIP) joint (the avulsed bony distal fragments become caught in the A4 pulley preventing further retraction)
type IV: combined bony avulsion and tendon avulsion from the bony fragment ("double avulsion” with subsequent retraction of the tendon usually into the palm)
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type V: ruptured tendon with bone avulsion with bony comminution of the remaining distal phalanx
Va: extra-articular
Vb: intra-articular
Treatment and prognosis
Management of these injuries is highly dependent on the classification and can range from a simple pull-out suture to open reduction internal fixation with tendon fixation 1-3:
type I: tendon should be repaired with prompt surgical treatment within 7 to 10 days
type II: tendon should be repaired within several weeks for optimal outcome
type III: tendon should be repaired within several weeks for optimal outcome
type IV: if tendon separated from fracture fragment, fracture should be first fixed then the tendon is reattached as for type I/II injuries
type V: stability of the DIP joint should be obtained before fixation of the avulsed osseous fragment 1
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