Introduction Jersey fingers are traumatic avulsions of the flexor digitorum profundus (FDP) tendon. Classified according to the Leddy-Packer classification system, there are 5 types. Type II injuries are most common followed by type III. There is no exact data on incidence rates of these injuries, however the ring finger is the most commonly injured finger in this pathology. We present a case of a healthy 39 year-old-male with right ring finger type IV avulsion - FDP tendon and an intra-articular bone fragment from the base of the distal phalanx – Figure 1. The tendon is avulsed from the bone fragment, a double injury. Methods Our patient underwent open reduction internal fixation (ORIF) of the bony fragment and a pull-over repair of the FDP tendon to the distal phalanx (Figure 1-4). The patient proceeded to have early active protocol hand therapy following fixation as there was no k-wire transfixing the DIPJ. This allowed early active tendon rehabilitation and a good functional outcome. Literature review A literature review identified 20 previously reported cases of a type IV avulsion injury. 3 ORIFs were performed without K-wire fixation. All other reported fixation techniques utilised K-wires to cross the DIPJ and stabilise the fragment, preventing early active hand therapy. Outcomes At 3 months follow up the patient had excellent TAM of the affected finger.