FINGER TIP INJURY OF LEFT MIDDLE 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 C ASE REPORT DESEMBER 2014 ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT MEDICAL FACULTY HASANUDDIN UNIVERSITY
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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,
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