Finger Tip Injury of the Right Index Finger (2)

Finger tip injury of the right index finger

Muh. Khaerisman C 111 07 159

Supervisorrdr. M. Ruksal Saleh, Phd., Sp. OT (K)

Advisor : dr. Yoga Datasarya K.dr. Denal Bato Tampak

ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENTFACULTY OF MEDICINE

HASANUDDIN UNIVERSITYMAKASSAR

2013

Name : EAge : 19 years old / MaleAdmission : January 3rd , 2012 at 19.22Registration: 587061Address : Panaikang Makassar

IDENTITY

Chief Complaint : Wound at the right index finger

Suffered since 5 days ago due to entrapped into the motorcycle gear. The patient was cleansing the motorcycle when the motorcycle engine was on and suddenly, his index finger entrapped into the gear.History operation since 5 days ago after the injury.Patient is student college with right hand dominant.

HISTORY TAKING

PHYSICAL EXAMINATION

GENERAL STATUS :Moderate illness/concious/good nourish

VITAL STATUS:Blood Pressure : 110/70 mmHgPulse : 80 x/minRespiratory rate : 20x/minTempature : 36, 60C

LOCAL STATUS

Right hand regionI : Wound at tip of the right index finger,

deformity (-), swelling (+), hematoma (-), bone exposed (+).

P : Tenderness (+)ROM : Active and passive motion at MCP and IP joint of

the thumb is within normal limit Active and passive motion at MCP, PIP, DIP joint

of middle, ring and little fingers are within normal limit

Active and passive motion at MCP PIP and DIP of index finger within normal limit and DIP

NVD : Sensibility can not be evaluated.

LABORATORY FINDINGS

• WBC 8,07 x 103 /uL• RBC 5,33x 106 /uL• HGB 14,3 gr/dL• HCT 42,7 %• PLT 301x 103 /Ul• CT 8’00”• BT 2’00”• HbsAg negative

RADIOLOGY FINDINGS

RESUME A male, 19 years old came to the Wahidin Sudirohusodo

Hospital with chief complaint is Wound at the right index finger

Suffered since 5 days ago before admitted to the Wahidin Sudirohusodo hospital due to entrapped into the motorcycle gear. The patient was cleansing the motorcycle when the motorcycle engine was on and suddenly, his index finger entrapped into the gear. History of operation sudden the injury.Patient is right hand dominant.

Wound at tip of the right index finger, deformity (-), swelling (+), hematoma (+), dirty wound (+), bone exposed (+) Tenderness (+).

DIAGNOSIS

Finger tip injury of the right index finger

MANAGEMENT

• Antibiotic• Wound care• Plan for wound closure

DISCUSSION

Definition and anatomy

Fingertip injuries are defined as those injuries occurring distal to the insertion of the flexor and extensor tendons

EPIDEMIOLOGY

• In adults, injuries are commonly due to occupational activities

• Injuries in children limit their daily activities like eating, playing and schoolwork

• the incidence is highest in younger children and boys

CLINICAL

•Any type of pinching, crushing, or sharp cut to the fingertip injury to the nail bed.

• Common injuries include crush injuries to the fingertip – subungual haematoma, – nail bed laceration, – partial or complete amputation of the fingertips,– pulp amputations and fractures of the distal

phalanges)

Allen CLASSIFICATION

Type 1 involving the pulp only. Type 2 injury to the pulp and nail bed. Type 3 injuries include distal phalangeal fr, associated pulp and nail loss. Type 4 injuries involve the lunula, distal phalanx, pulp and nail loss.

TREATMENT

• The goal of treatment is to have a pain-free fingertip that is covered by healthy skin and hand should be able to feel, pinch, and grip, and you should be able to perform normal hand functions.

• preserve the length and appearance of finger.• treat a fingertip injury depends on the angle

of the cut and the extent of the injury..

• Injuries with loss of skin alone can heal by secondary intention or can be covered by a skin graft.

• A free skin graft can be used for coverage, but normal sensibility is never restored

• Abrasion injury to left hand treated by secondary-intention healing. A, Volar view soon after injury with 2 cm × 2 cm full-thickness pulp skin loss of middle and ring fingers. B, Same fingers with local wound care at 4 weeks. C, Result at 8 weeks with no operative intervention.

• If deeper tissues and skin must be replaced to cover exposed tendon and bone, various flaps or grafts can be used.

HEALING BY SECONDARY INTENTION

• Begin treatment with a thorough debridement of the wound, which can be performed under local anesthesia in the emergency room.

• 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

LOCAL FLAPSV-Y Advancement Flap

Kutler V-Y advancement flaps.

• A. Advancement flaps over neurovascular pedicles carried down to bone.

• B–D, Fibrous septa are defined (B) and divided (C), permitting free mobilization on neurovascular pedicles alone (D). E, Flaps advance readily to midline.

Atasoy V-Y techniqueA, Skin incision and

mobilization of triangular flap.

B, Advancement of triangular flap.

C, Suturing of base of triangular flap to nail bed.

D, Closure of defect, V-Y technique.

Dorsal pedicle flap A, Flap has been outlined. B, Flap has been elevated,

leaving only a single pedicle.

C, Flap has been sutured in place over end of stump, and remaining defect on dorsum of finger has been covered by split-thickness skin graft.

thenar flap Middle and ring finger flap

A, Tip of ring finger has been amputated.

B, Finger has been flexed so that its tip touches middle of thenar eminence, and thenar flap has been outlined.

C, Split-thickness graft is to be sutured to donor area before flap is attached to finger.

D, Split-thickness graft is in place. E and F, End of flap has been

attached to finger by sutures passed through nail and through tissue on each side of it.