Injury
Injury
Traumatically-amputated fingers and hands are replanted (reattached) by us routinely and successfully since 1991.
Case Study
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.
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
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.
Finger Tip Injury
Finger tip is the part of the finger close to the nail before the adjacent joint of the finger, it is the commonest injury seen in a hand surgery clinic.
Cause
It usually follows the finger getting jammed in the door or caught in a machine. The spectrum of fingertip injuries may be confined to just avulsion of the nail plate to amputation of the fingertip.
Nail is lost
If the nail is avulsed, it is necessary to thoroughly clean the part to eliminate all contamination, eliminate any possibility of infection and then to re position the nail. This step ensures that the new nail grow nicely.
Fingertip is amputed
The part may be reattached by microsurgery. On other occasions the fingertip is reconstructed. Ultimate aim is to provide length and cosmetically acceptable finger.
Finger Flap Surgery
An island of skin which has its own blood supply is called a flap. When the skin is lost due to trauma or for any other reason and the bone or tendon are exposed or the wound is deep, it will need a robust skin cover which has a blood supply. While a large number of wounds heal with the passage of time, others require a flap cover.
Case Study
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
The wound on the finger had exposed extensor tendon. It is important to cover the tendon early, otherwise they will desiccate and will be lost. The extensor tendon was covered with a transposition flap.
Slashed Wrist
A sharp weapon or a glass edge can severe the tendons, nerve and the blood supply requiring urgent repair of all the structures. Such an injury is called a slashed wound. Sometimes, almost 12 tendons, 2 nerves and 2 arteries can get severed.
Case Study
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.
Nerve Injury
Nerves are structures which connect hand to the brain. They provides sensation and control the movements of the muscles. When the nerves are cut, a person may lose sensation to a certain part of the hand. Or function of a certain muscles may be lost depending on the location of the injury. The nerves are extremely delicate structures. They have to be repaired very early for optimum recovery. With passage of time, the quality of recovery gets poorer and sub-optimal. The repair is done under magnification to match the cut fibers. The repair material is barely visible to naked eyes and measured in microns or repaired with a special glue. The repair is done without any tension at the repair site. With passage of time, the nerve retracts. This means an early repair is the good repair. If the injury is present for quite some time, the nerve will retract. In such a scenario, the gap in the nerve is bridged and grafted with another spare nerve harvested from some other part of the body.
During Treatment
Fall of a glass piece on the forearm of a six years old child. The site of profuse bleeding and shrieking of the child raised an alarm in the family and the neighbourhood. Sharp injury is generally suggestive of nerve injury, hence wound was explored. Sure enough, the Ulnar nerve was found severed.
The Ulnar nerve repaired under microscope.
