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CASE REPORT

DESEMBER 2014

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

ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT
MEDICAL FACULTY
HASANUDDIN UNIVERSITY

IDENTITY




Name
: Mr. AM
Age
: 23 y.o
Gender
: Male
Registration
: 691931
Admission : December 7th, 2014

AUTOANAMNESIS
Chief 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.

diameter 2. HR=80x/min. pupil isochoric. regular D : GCS 15 (E4M6V5). spontaneous.5 mm.7oC (axilla) .5 mm/2.PRIMARY SURVEY A : Clear B : RR=20x/min. strong. light reflex +/+ E : T=36. thoracoabdominal type C : BP=120/80 mmHg. simetris.

index. size 2x1. ring. and little finger are normal .5cm. swelling (+) • Tenderness (+). bone exposed (+). PIP and DIP joint of the thumb. 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. NVD: sensibility is good. hematome (+). pulsation of radial and ulnar artery is good. deformity (+).SECONDARY SURVEY Look Feel • Wound at the tip of middle finger.

CLINICAL FINDINGS .

RADIOLOGY FINDINGS X-Ray manus sinistra AP/Oblique .

47 x 10⁶/uL HB 15.0 g/dL HCT 44.0 % PLT 272 x 10³/uL CT 6'00" BT 2'30" .LABORATORY FINDINGS 07/12/2014 WBC 11.1 x 10³/uL RBC 4.

deformity (+). tenderness can be felt.5cm. • Radiological findings: there is bone loss at tip of distal phalanx of the left middle finger. Patient is a mechanic and right handed dominant.RESUME • Male. suffered since 30 minutes ago before admitted to Wahidin General Hospital. 23 y. Patient was repairing his motorcycle.o. • From physical examination: wound at the tip of middle finger. bone exposed (+). swelling (+). came to the hospital with wound at left middle finger. From palpation. . hematome (+). History of prior treatment (-). size 2x1. and accidentally his left middle finger trapped into motorcyle’s gear.

Allen type IV .DIAGNOSIS Finger tip injury of left middle finger.

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. .

Hand injuries represent 11-14% of on-the-job injuries and 6% of compensation paid injuries. .EPIDEMIOLOGY About 10% of all accidents encountered in the ED involve the hand. especially in young men who perform manual labor. Damage to the nail bed is reported to occur in 15-24% of fingertip injuries. is common. Injury to the fingertip.

ETIOLOGY Common types of injuries include blunt or crush injuries to the fingernail Burns and frostbite commonly involve fingertips Sharp or shearing injuries from knives and glass result in lacerations and avulsion types of soft tissue defects .

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 .

. • Reserved for small defects (6 to 8 mm) without exposed bone and with minimal loss of pulp tissue. Healing is usually completed by 3 to 6 weeks depending on the size of the defect. • Perform local wound care two to three times daily with dressing changes. • Begin treatment with a thorough debridement of the wound.HEALING BY SECONDARY INTENTION • This method relies on reepithelialization and contracture to provide wound closure.

Regional Flap 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 .

THANK YOU .