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HANDOC Case Study Newsletter

Case Study Newsletter

Summer 2016


Welcome to the HANDOC Case Study Newsletter where we present some recent hand and wrist injuries, together with some useful diagnostic and treatment insights for our referrers. 1300HANDOC offers a comprehensive 24/7 streamlined service for acute management of workplace hand and wrist injuries in Western Australia.

 

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HANDOC is operated by WA’s largest group of specialist hand surgeons. Call 1300HANDOC for immediate triage or advice.

CASE STUDY 1
Martini Glass Laceration

Summary

Mr A, a 23-year-old barman, pierced his right palm with the stem of a martini glass, resulting in a penetrating wound to his right thenar eminence. He presented to his regional emergency department 3 days post injury with concerns of distal numbness to the radial border of his right thumb.

He was then referred to 1300HANDOC where clinical assessment by one of our specialist hand surgeons indicated that his radial digital nerve had probably been divided. Mr A had the nerve explored and repaired under magnification. Dressings were applied and a Zimmer splint was fitted. Sutures and the splint were removed after 3 weeks and he was seen by a local hand therapist for desensitisation and ongoing therapy.

Clinical Insight

Even hand injuries which are perceived to be minor, carry risks of significant damage to underlying structures. Surgical repair is required to restore the integrity of the nerve. Once repaired, the nerve’s fibres regenerate slowly at an estimated growth of approximately 1-1.5mm per day. As the fibres regenerate slowly over the following months, sensory deficit will improve. Maximal medical improvement isn’t normally seen until several months post operation and prognosis for full recovery is generally cautious.
Area of sensory deficit marked out by patient
Intraoperative showing retraction of the two ends of the dissected nerve
Intraoperative showing
approximation of the two ends
Nerve post suturing

CASE STUDY 2
Pulley Crush

Summary

Mr B, a 26-year-old driller’s offsider, caught his right index finger in a pulley, resulting in a crush injury. The crushing force resulted in an open fracture at the base of the distal phalanx and avulsion of his extensor tendon. The laceration extended into the nail bed and through the germinal matrix, with contusion of the soft tissues and proximal nail bed loss. He was seen immediately by his onsite medic, had his ADT updated and was given oral antibiotics. After review by a regional emergency department, Mr B was referred to 1300HANDOC. His transfer to Perth was arranged and same-day surgery carried out by one of our specialist hand surgeons. In surgery, Mr B’s nail plate was removed, his wounds washed and debrided to healthy tissue and a 1mm k-wire inserted through the DIP joint to stabilise his distal phalanx fracture.

One week following surgery, Mr B returned to the clinic to have his dressing changed and he was fitted with a thermoplastic mallet splint. Four weeks after the operation, Mr B had his k-wire removed but splinting continued for a further 2 weeks and he commenced mobilisation. Two months post injury, despite the loss of some nail bed tissue, normal nail growth occurred.

Clinical Insight

The benefit of an intact and healthy nail is to provide protection from injury to the fingertip and associated structures. Healthy fingernail growth and adherence to the nail bed facilitates the delicate movements of the distal digits through counter-pressure applied to the pulp of the finger, which enhances proprioceptive feedback.
Preoperative injury
Preoperative injury & X-ray
Post operative
Postoperative flexion
CALL 1300HANDOC FOR HAND INJURIES

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