Irreducible phalangeal fracture in a child due to flexor tendon entrapment

A 4-year-old girl sustained a longitudinal shaft fracture of the proximal phalanx of the ring finger. The fracture was irreducible by closed manipulation and required open reduction. The fragments were separated by both flexor tendons near the level of Camper's chiasma, which caused a "pinching" phenomenon when manipulative reduction was attempted. The case presented reveals that an irreducible fracture should be suspected in hyperextension injuries with severe angulation when rubbery resistance is noted at the time of closed manipulation.