3 Phalanx IM screws

History: 39 year old gentleman came to the office after a steel beam fell on his hand, crushing his index, middle, and ring fingers.  He had fractures of the proximal phalanx to all three fingers and limited motion, swelling, and pain. 

Diagnosis: P1 fractures of index, middle, ring fingers

 

Treatment: Index and Middle fingers intramedullary screw, Ring finger pinning

Outcome: At 2.5 months he had nearly full motion and no pain.  The index and middle fingers were significantly better than the ring finger in regards to motion. 

Table Saw Skin Graft

History: 63 year old gentleman sustained a table saw injury to his right index finger.  This included a deep skin injury with full thickness loss but did not seem to involved the tendons, nerves, or vessels.  

Diagnosis: Right index full thickness loss

Treatment: Full thickness skin graft to digit

Outcome: Despite early loss of part of the graft, the entire wound quickly granulated in resulting in full coverage, full motion, and return to full activities. 

PIP Joint ORIF

History: A 19 year old gentleman injured his middle finger joint while punching a wall.  He presented to my office with an inability to flex and extend his middle finger and with pain and swelling. 

Diagnosis: Middle finger PIP joint intra-articular fracture with subluxation, moderately improved with traction

Treatment: Middle phalanx open reduction, internal fixation with screws

Outcome: He did exceptionally well.  At his first post-op visit he could nearly make a full fist and within 2 months he had nearly full motion without any pain. 

Mallet Finger CRPP

History: 31 year old female administrator injured her finger about 3 weeks prior to seeing me in the office.  She had a fracture-dislocation of the finger tip, also known as a mallet finger or mallet fracture with dislocation. I recommend surgical treatment.  To avoid making an incision, I recommended percutaneous pin treatment. 

Diagnosis: Right ring finger mallet fracture dislocation

Treatment: Percutaneous reduction with pinning.  Intra-operative technique shown here. 

 

 

 

 

 

   

Outcome: The small fragment pin was removed in the office after 6 weeks.  The longitudinal pin was removed after 10 weeks because she could not make an earlier appointment.  She had no pain, fully healed, and was using her finger normally.  By her last visit, some bridging bone could be seen across the fracture. 

 

P1 Percutaneous Screws

History: 40 year-old male school principal came to my office after injuring his finger playing basketball and jamming the finger. He had significant pain and swelling and was unable to make a fist. X-rays showed a fracture of the proximal phalanx with displacement and rotation.

Diagnosis: Left 5th proximal phalanx oblique fracture

Treatment: Proximal phalanx closed reduction with percutaneous screws

Outcome: Within 3 weeks he had near full motion. Aside from some mild swelling he had no pain. Because the screws were percutaneous, or through the skin, there was no scar and no incision.

P1 Intramedullary Screw

History: 31 year-old male had a crush injury to his right middle finger.  He worked as a registered dental assistant and it was important that he could return to wearing gloves and working as quickly as possible.  X-rays showed a comminuted fracture of the proximal phalanx (finger) with more than 25 degrees of angulation in the lateral view and 15 degrees of angulation in the AP view. 

Diagnosis: Right long finger proximal phalanx fracture

Treatment: Right long finger proximal phalanx open reduction and internal fixation with intramedullary screw

Outcome: The patient had surgery on a Friday morning and returned to work on Monday morning. He removed his own splint and aside from mild soreness and swelling was able to wear gloves and perform his typical work. When he arrived for his first post-operative visit 10 days after surgery he had minimal pain and nearly normal motion even before the stitches were removed.

X-rays at 10 days showed good overall alignment. 

P1 Derotation Osteotomy

History: 21 year-old female who fractured her left index finger in a car accident 2 years ago.  She was treated without surgery which resulted in the bone healing with a rotational deformity.  She notices that her index finger crosses over her other fingers when she makes a fist. 

Diagnosis: Left index proximal phalanx rotational malunion

Treatment: Left index finger proximal phalanx derotational osteotomy with locking blade plate

Outcome: After re-fracturing and fixing the bone in proper alignment, she no longer had “crossing over” of the index finger with flexion.  She worked hard with physical therapy and regained nearly all of her motion without any pain in the finger. 

Great motion and no pain about 4 months after surgery.