Case Studies
Delayed Treatment of a Finger Injury Salvaged by a Skin Transfer.
An injury to the finger was delayed by the victim for 4 months presuming it to be a minor trauma. Over time, the joint got infected and irreversibly damaged. The wound started growing in size. At this point, the gentleman sought treatment. The damage was halted and the wound was covered with a robust skin cover.The wound healed An injury to the finger was delayed by the victim for 4 months presuming it to be a minor trauma.Over time, the joint got infected and irreversibly damaged. The wound started growing in size. At this point, the gentleman sought treatment. The damage was halted and the wound was covered with a robust skin cover. The wound healed.
Diabetic Foot Case Study 1
The nerve decompressions helped in the healing of the wound over the sole. The wound had existed for several years. She is able to feel the ground.
Diabetic Foot/Charcot Foot/Deformity Foot/Burning Sensation Sole
Diabetic patients are known to suffer from complications affecting the blood and nerve supply of the foot besides other organs. These are described under a standard heading called diabetic foot. When the nerves of the foot are affected, the person may not feel the floor. S/he may have an annoying burning sensation in the sole, disturbing sleep. It is possible to reverse this problem. The bones and the joints are damaged due to the loss of protective feedback from the nerves. The condition is called Charcot Diabetic Neuroarthropathy or Charcot Joint. The affection of the foot or ankle is prevented and corrected surgically by inserting thick screws along the length of the foot.
Finger Flap Surgery Case Study 1
The wound over the finger did not heal for a very long time and the tendon which extends the finger was also exposed. This was covered with the flap which was hitched from one location to another with an intact blood supply.
Flap Surgery. Case Study 2.
This person was injured, sustained a large wound on the dorsum of the hand with the extensor tendons exposed. The wound was covered with a flap. The flap is called Posterior Interosseous Artery (PIA) flap. Based on a known artery, an appropriately sized skin island is reflected from the forearm to the dorsum of the hand. The rehabilitation is important to prevent stiff fingers. As one will appreciate, he regained full movements of the fingers with appropriate dynamic splinting. This person was injured, sustained a large wound on the dorsum of the hand with the extensor tendons exposed. The wound was covered with a flap. The flap is called Posterior Interosseous Artery (PIA) flap. Based on a known artery, an appropriately sized skin island is reflected from the forearm to the dorsum of the hand. The rehabilitation is important to prevent stiff fingers. As one will appreciate, he regained full movements of the fingers with appropriate dynamic splinting. After
Fracture of the Wrist Fracture Distal Radius/Colles’ Fractures
A trivial fall and landing on the wrist can break one’s wrist bone. An x-ray may reveal a fracture which is variably called Fracture distal radius or “(historically: Colles fracture). It may be treated with a plaster alone or wires or plate. Various parameters are taken into consideration to decide the best method of treatment.
Game Keeper Thumb. Case Study
It is an injury to the ligament of the thumb due to a fall with the load of the body transmitted to the thumb. Following a fall on the stretched-out thumb, the person gets swelling and pain on the inner aspect of the centre of the thumb. A special X-Ray called a stress view is obtained. To get a stress X-Ray view, the injured area is very gently deviated and stress to assess the extent of ligament injury. If the ligament is totally torn, the joint will open out abnormally and will be visible on the X-Ray. This shows abnormal opening on the medial (inner) side of the thumb. There may be a bony avulsion or purely ligament injury. In the normal thumb, the ligament is deep and muscle is superficial. In this condition, the injury causes the ligament to come to lie more superficial to the muscle. This reversal of the location of these structures is called as Stener lesion. This requires surgery to correct the Stener lesion. Special very tiny anchors may be required to fix the avulsion if bone is not of adequate size. Case Study Stress x ray shows abnormal opening on medial side of the thumb. It is an injury to the ligament of the thumb due to a fall with the load of the body transmitted to the thumb. Following a fall on the stretched-out thumb, the person gets swelling and pain on the inner aspect of the centre of the thumb. A special X-Ray called a stress view is obtained. To get a stress X-Ray view, the injured area is very gently deviated and stress to assess the extent of ligament injury. If the ligament is totally torn, the joint will open out abnormally and will be visible on the X-Ray. This shows abnormal opening on the medial (inner) side of the thumb. There may be a bony avulsion or purely ligament injury. In the normal thumb, the ligament is deep and muscle is superficial. In this condition, the injury causes the ligament to come to lie more superficial to the muscle. This reversal of the location of these structures is called as Stener lesion. This requires surgery to correct the Stener lesion. Special very tiny anchors may be required to fix the avulsion if bone is not of adequate size. Case Study Stress x ray shows abnormal opening on medial side of the thumb. A tiny Anchor just before insertion. After repair and insertion of anchor
Injury & Finger Amputation Case study 2
Amputation at the level of the nail, reattached with the help of microvascular surgery. The Surgery is done under massive surgical microscope & successful reattachment requires using stitching material fine almost like a cobeweb, measurable in microns & instruments called micro instruments. Amputation at the level of the nail, reattached with the help of microvascular surgery. The Surgery is done under massive surgical microscope & successful reattachment requires using stitching material fine almost like a cobeweb, measurable in microns & instruments called micro instruments. After
Injury & Finger Amputation Case study 3
Amputation of the fingers, reattached with the help of microvascular surgery. The Surgery is done under massive surgical microscope & successful reattachment requires using stitching material fine almost like a cobeweb, measurable in microns & instruments called micro instruments. Amputation of the fingers, reattached with the help of microvascular surgery. The Surgery is done under massive surgical microscope & successful reattachment requires using stitching material fine almost like a cobeweb, measurable in microns & instruments called micro instruments. After
Injury>Amputation of the Upper Arm. Case Study 1.
8 years old sustained an amputation of the arm in a road accident. The child reported to the hospital after 3 hours with the hand in a polythene bag! Within minutes the arm was in the operation theatre. In an overnight surgery the arm was successfully reattached. The boy is a grown-up married man and gainfully employed! This was done in 1996! First for the city of Pune. 8 years old sustained an amputation of the arm in a road accident. The child reported to the hospital after 3 hours with the hand in a polythene bag! Within minutes the arm was in the operation theatre. In an overnight surgery the arm was successfully reattached. After surgical reattachment of the arm. Great recovery of right arm. The boy is a grown-up married man and gainfully employed! This was done in 1996! First for the city of Pune.
Jammed Finger After Cricket Ball Injury
In a cricket playing country , a common presentation is inability to flex the finger after getting hit with ball.In the absence of early and appropriate treatment, the finger may loose the movements. Early visit to a hand surgeon will be beneficial.The treatment begins with an appropriate magnified x-ray view of the injured finger.The joint may be fractured and also dislocated.The HAND Surgeon will assess the extent of injury and its displacement. The treatment may be a moulded external support without surgery or it may require some kind of surgery.But it is mandatory to visit a specialist HAND SURGEON early in case of inability to completely move the finger. Multiple treatment options are available: Close manipulation and correction of dislocation. Close reduction and wire fixation. External Fixation. Suzuki frame is a common name, but many variations are available. Open reduction and Volar Plate interposition. Cartilage bearing bone transfer>> Hemi Hamate Transfer. Cartilage bearing bone transfer>> Capitate Transfer. In a cricket playing country , a common presentation is inability to flex the finger after getting hit with ball.In the absence of early and appropriate treatment, the finger may loose the movements. Early visit to a hand surgeon will be beneficial.The treatment begins with an appropriate magnified x-ray view of the injured finger.The joint may be fractured and also dislocated.The HAND Surgeon will assess the extent of injury and its displacement. The treatment may be a moulded external support without surgery or it may require some kind of surgery.But it is mandatory to visit a specialist HAND SURGEON early in case of inability to completely move the finger. Multiple treatment options are available: Close manipulation and correction of dislocation. Close reduction and wire fixation. External Fixation. Suzuki frame is a common name, but many variations are available. Open reduction and Volar Plate interposition. Cartilage bearing bone transfer>> Hemi Hamate Transfer. Cartilage bearing bone transfer>> Capitate Transfer.
Noted Hand Surgeon Successfully Achieves Landmark of 30k Complex Surgeries
Pune-based noted hand surgeon vividly remembers the first patient he had operated upon way back in 1991. The boy was just 14 and a constricted plaster cast to heal a minor hand injury led to a series of complications including 14 operations. “The boy’s nerve got cut, paralysing muscles, and even the bone got infected. The rod that was fitted in the forearm led to further complications. I remember for the hand reconstructive surgery, we tabulated the problems in the bones, joints, nerves , skin and tendons. For the bone, a device was custom-made in our own workshop. The skin was imported from the abdominal wall and the tendon came from the inner leg. The nerve was harvested from the outer aspect of the leg,” Dr. Jindal recalled. Over the following months, the joints were kept supple through intense tailor-made therapy and the brain signals were activated through dynamic devices. “The sincerity and perseverance of the patient and his parents paid off and the boy could use his hand again,” Dr. Jindal said adding that now at 47, he is among the top management consultants at a private firm and avidly participates in rock climbing expeditions. Be it dealing with with patients with severe burns or reattaching amputated parts, over the last three decades or so, Dr. Jindal has completed a landmark 30,000 complex surgeries. “There have been several patients with acute hand trauma, birth defects of the hand, suffer from arthritic hands while there are others who have to deal with compression neuropathy in their hands and feet,” Dr. Jindal recalls. Having performed over 50 reimplantations of completely severed /amputated hands, Dr. Jindal, a consulting hand surgeon at Ratna Memorial hospital, is actively engaged in conducting charity surgical camps to correct hand deformities. “More than 900 patients have been surgically treated in these camps and children suffering from spasticity due to cerebral palsy and congenital deformity are given priority. Often this group of patients are laborers or from the economically weak section. They lack the money necessary for treatment and medicines,” Dr. Jindal said. He added that with the support of social organisations such as Rotary International, Lions’ Club, Agrawal Club and Rasiklal Manikchand Dhariwal Foundation, camps are conducted to surgically treat the patients. “If the hand has a deformity or suffers a serious injury in an accident, then the affected person has to face a number of problems. It was because of this that I chose to develop expertise in hand surgery after obtaining a degree in orthopedics and later taking up further studies in France and Switzerland,” Dr. Jindal, who also formerly chaired the hand surgery section at the Indian orthopedic Association and delivered more than 200 lectures across India and abroad, said. https://indianexpress.com/article/cities/pune/noted-hand-surgeon-30k-complex-surgeries-9380223/
Scaphoid Fracture
Fracture of the wrist can occur following a fall on an outstretched hand. The pain and local swelling of the wrist are often mild and can lead to Overlooking the injury. The hand surgeon will get x rays with special views of the affected wrist. The treatment may vary from plaster cast to surgery. The surgeon will discuss with you the options available for your speedy recovery Fracture of the wrist can occur following a fall on an outstretched hand. The pain and local swelling of the wrist are often mild and can lead to Overlooking the injury. The hand surgeon will get x rays with special views of the affected wrist. The treatment may vary from plaster cast to surgery. The surgeon will discuss with you the options available for your speedy recovery. X ray of the wrist shows fracture of the scaphoid. After
Slashed Wrist Case Study 1
Sharp injury to the wrist cutting tendons, nerves and artery. After rehabilitation, good recovery was seen, with good finger movements.The nerve recovery is slow and takes some time. It may need a procedure called tendon transfer after a while to augment residual functional loss. Sharp injury to the wrist cutting tendons, nerves and artery. After rehabilitation, good recovery was seen, with good finger movements. The nerve recovery is slow and takes some time. It may need a procedure called tendon transfer after a while to augment residual functional loss.
Syndactyly Case Study 1
The surgery involves, creating a web so that the two fingers are separated by a U and not a V, creating a nice nail fold. It prevent fingers contracting due to skin deficiency. The surgery may be followed by a session of therapy to prevent contractures.
Syndactyly Case Study 2
Fingers are joint since birth. One year after surgical separation of fingers and creating normalcy.
Ulnar Nerve Compression Case Study 1
Tingling in the finger is a common symptom. When the tingling is in the small finger, often it is due to compression of the ulnar nerve at the elbow. Initially the symptoms are confined to tingling alone .In due course, there may be onset of finger weakness and inability to extend the ring and small fingers. Activity modification may at times help. If symptoms persist, this may require surgery. There are various types of procedures available for alleviating the symptoms. One of them is ulnar nerve decompression with or without anterior transposition.
Ulnar Nerve Compression Case Study 2
Non union lateral condyle humerus The child had an injury earlier leading to non-union of lateral condyle of the distal humerus. The progressive deformity of the elbow lead to ulnar nerve stretching. The ulnar nerve was surgically freed and transposed anteriorly. The child had an injury earlier leading to non-union of lateral condyle of the distal humerus. The progressive deformity of the elbow lead to ulnar nerve stretching. The ulnar nerve was surgically freed and transposed anteriorly.
