Case Report Finger Tip Injury

FINGER TIP INJURY OF LEFT MID-DLE FINGER

ALLEN TYPE IV

Presented by:Mayanti Virna Patabang C11109371

Advisors:dr. Edwin William T.

dr. Denal Bato Tampak

Supervisor:dr. Henry Yurianto, M.Phil, Ph.D, Sp.OT

CASE REPORTDESEMBER 2014

ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENTMEDICAL FACULTY

HASANUDDIN UNIVERSITY

IDENTITY• Name : Mr. AM• Age : 23 y.o• Gender : Male• Registration : 691931• Admission : December 7th, 2014

AUTOANAMNESISChief complain: wound at left middle finger• Suffered since 30 minutes ago before admitted to

Wahidin General Hospital.• Patient was repairing his motorcycle, and

accidentally his left middle finger trapped into motorcyle’s gear .• History of prior treatment (-).• Patient is a mechanic and right handed

dominant.

PRIMARY SURVEYA : Clear

B : RR=20x/min, simetris, spontaneous,

thoracoabdominal type

C : BP=120/80 mmHg, HR=80x/min, strong,

regular

D : GCS 15 (E4M6V5), pupil isochoric, diameter

2,5 mm/2,5 mm, light reflex +/+

E : T=36,7oC (axilla)

SECONDARY SURVEY

Look

• Wound at the tip of middle finger, size 2x1,5cm, bone exposed (+), deformity (+), hematome (+), swelling (+)

Feel

• Tenderness (+), NVD: sensibility is good, pulsation of radial and ulnar artery is good, CRT < 2”

Move

• Active and passive movement of the wrist joint normal• Active and passive movement of the MCP and IP joint of the middle finger are

normal• Active and passive movement of the MCP, PIP and DIP joint of the thumb,

index, ring, and little finger are normal

CLINICAL FINDINGS

RADIOLOGY FINDINGS X-Ray manus sinistra AP/Oblique

LABORATORY FINDINGS

07/12/2014

WBC 11,1 x 10³/uL

RBC 4,47 x 10⁶/uL

HB 15,0 g/dL

HCT 44,0 %

PLT 272 x 10³/uL

CT 6'00"

BT 2'30"

RESUME• Male, 23 y.o, came to the hospital with wound at left middle

finger, suffered since 30 minutes ago before admitted to Wahidin General Hospital. Patient was repairing his motorcycle, and accidentally his left middle finger trapped into motorcyle’s gear. History of prior treatment (-). Patient is a mechanic and right handed dominant.

• From physical examination: wound at the tip of middle finger, size 2x1,5cm, bone exposed (+), deformity (+), hematome (+), swelling (+). From palpation, tenderness can be felt.

• Radiological findings: there is bone loss at tip of distal phalanx of the left middle finger.

DIAGNOSIS

Finger tip injury of left middle finger, Allen type IV

MANAGEMENT• Antibiotic• Analgesic• Tetanus toxoid• Debridement + open wound care• Plan for wound closure

DISCUSSION

ANATOMY

ANATOMY

INTRODUCTION• Fingertip injuries are defined as those

injuries occurring distal to the insertion of the flexor and extensor tendons.• They are the most common injuries of the

hand and can lead to a significant functional and cosmetic deficit if they are not treated appropriately.

EPIDEMIOLOGYAbout 10% of all accidents encountered in the ED involve the hand. 

Hand injuries represent 11-14% of on-the-job injuries and 6% of compensation paid injuries.

Damage to the nail bed is reported to occur in 15-24% of fingertip injuries.

Injury to the fingertip, is common, especially in young men who perform manual labor.

ETIOLOGYCommon types of injuries include blunt or crush injuries to the

fingernail

Sharp or shearing injuries from knives and glass result in

lacerations and avulsion types of soft tissue defects

Burns and frostbite commonly involve fingertips

CLASSIFICATION

• Allen type I• Allen type II• Allen type III• Allen type IV

CLASSIFICATION

The angle of injury are shown

CLINICAL PRESENTATION

As certain the following information when gathering patient history:• Mechanism of injury• Hand dominance• Occupation and hobbies• Length of time since injury• Tetanus immunization status

Evaluate the finger tip injury to determine the following:• Crush versus sharp injuries• Nail or nail bed involvement• Bone involvement• Viability of tip• Presence of foreign body

TREATMENT

• This method relies on reepithelialization and contracture to provide wound closure.

• Reserved for small defects (6 to 8 mm) without exposed bone and with minimal loss of pulp tissue.

• Begin treatment with a thorough debridement of the wound.• Perform local wound care two to three times daily with

dressing changes. Healing is usually completed by 3 to 6 weeks depending on the size of the defect.

HEALING BY SECONDARY INTENTION

Local Flap

Atasoy-Kleinert V-Y Flap

Kutler Lateral V-Y Flap

Moberg Flap

Reg

iona

l Fla

p

Cross-finger Flap

Thenar and Thenar-H Flap

Island Flap

Atasoy-Kleinert V-Y Flap

Atasoy-Kleinert V-Y Flap

Kutler Lateral V-Y Flap

Thenar Flap

Thenar Flap

COMPLICATION• Nail ridge• Split nails• Hook nail deformities• Cold intolerance• Contracture

THANK YOU