Fig. 19. Profundus avulsion. Strong grasp against strong resistance may disrupt the insertion of the profundus tendon. (1.) As a pure soft tissue injury, the tendon may also avulse the vascular attachments of the vincula, retracting into the palm, devascularized and rapidly unsuitable for reattachment. (2,3,4.) Depending on its size, the fragment of a profundus avulsion fracture may prevent retraction. Vascularity is more likely to be preserved when the tendon end does not retract proximal to the proximal interphalangeal joint.