Complex Motorcycle Accident

History/Diagnosis: This patient sustained a very severe motorcycle accident with open injuries to the forearm, wrist, hand, and fingers.  There were fractures of the ulna, radius, ulnar styloid, thumb dislocation, metacarpals, and CMC joints.  I took her to the operative room for extensive surgery to repair and reconstruct all of the injuries.  

Treatment: Complex repair of all injuries.

Outcome: She did exceptionally well, essentially regaining full function and strength.  She returned to riding motorcycles, returned to work, and was very pleased!


Dorsal Wrist Skin Graft

History: 61 year old female sustained an injury to her right wrist resulting in complete loss of skin over a large area measuring 10 x 6 cm.  The existing skin had previously become infected and required debridement.  I recommended a skin graft to provide coverage to the area. 

Diagnosis: Dorsal wrist large skin defect

Treatment: Full thickness skin graft to wrist and hand

Outcome: Over the next 6 weeks the skin graft became fully incorporated and she regained full motion and full function of her hand. 


Thumb Arthritis

History: 51 year old female with right thumb pain that had been present for over a year.  Although it began after a fall, x-rays showed arthritis at the base of the thumb (CMC joint arthritis).  After trying splinting, a steroid injection, and anti-inflammatory medication, she elected for surgery to alleviate her pain. 

Diagnosis: Right thumb CMC arthritis

Treatment: Right thumb trapezium excision with ligament reconstruction and tendon interposition (LRTI)

Outcome: Her recovery proceeded smoothly and by 5 months after surgery she had regained full motion, had returned to all her activities, and no longer had any pain.  She was very happy. 

Bennett CRPP

History: 28 year-old male injured his thumb in an automobile accident when the airbag deployed.  He sustained a fracture of the thumb metacarpal base (Bennett fracture).  Based on the best evidence available, he elected for percutaneous surgical treatment. 

Diagnosis: Right thumb Bennett fracture

Treatment: Right thumb percutaneous pinning and cast


Outcome: After completing the cast and having the pins removed he recovered full motion and strength without any functional limitations. 

4th/5th MC Dislocation

History: 20 year-old male punched a wall with his right fist and had immediate pain and swelling over the the dorsal and ulnar aspect of the hand and wrist. X-rays demonstrated a fracture of the hamate bone with the 4th and 5th metacarpal bones dislocated dorsally. Live flouroscopic imaging in the office demonstrated that they could be reduced manually but were unstable.

Diagnosis: Right 4th and 5th carpal-metacarpal joint fracture dislocation

Treatment: Right 4th and 5th CMC Closed Reduction and Pinning


Outcome: He remained in a cast after surgery for 4 weeks. After 1 month he was transitioned to a removable splint and started on exercises for motion. 

By 2 months after surgery he had near-anatomic alignment of the joint, full motion, and no pain.


Metacarpal IM Screw

History: 30 year-old right-hand dominant male Sheriff impacted his left hand on concrete while wrestling a suspect.  He had immediate pain and swelling over the base of the index finger. X-rays showed a metacarpal fracture with displacement and angulation resulting in severe pain, swelling, and deformity.

Diagnosis: Left 2nd metacarpal fracture, displaced

Treatment: Percutaneous reduction and internal fixation with an intramedullary screw

Outcome: He had immediate return of motion.  After 2 months of working with therapy, he had full healing, no pain, complete return of motion, and returned to work as a sheriff.  The scar was not noticeable. X-rays showed the bone was in perfect alignment.

No pain and nearly normal motion at 2 months after surgery! 

Thumb Amp FDMA Flap

History: 25 year-old male injured his left thumb using a table saw resulting in an amputation of the thumb at the level of the interphalangeal joint. X-rays showed a partial thumb amputation.  He came to the emergency department with pain, disability, and bleeding. 

Diagnosis: Left thumb amputation at interphalangeal joint

Treatment: First dorsal metacarpal artery island flap

Outcome: He developed full healing and full use of his thumb within 2 months without difficulty.