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The nail bed was intact. However, there was circumferential
laceration over the volar distal interphalangeal joint region.
This communicated with the open distal phalanx fracture.
The most-radial aspect of the base of the distal phalanx was
pulled distally and was attached to the flexor tendon. I
reduced this fragment and pinned it with a K-wire. I then
reduced the contralateral base of the distal phalanx with a
K-wire crossing the distal interphalangeal joint. When I was
finished, I had excellent reduction and a stable fixation.
This, indeed, placed the flexor tendon back into its anatomic
position. The wound, which I did extend, was copiously
irrigated and closed with interrupted 4-0 nylon.
We then turned our attention to the ring finger. There was a
nail bed injury. The nail bed was removed. The complex
laceration was repaired with interrupted 4-0 nylon. The patient
had a displaced distal phalanx fracture which was transverse in
nature. I then was able to place a K-wire across the fracture
site and obtain anatomic alignment of the distal phalanx. C-arm
imaging confirmed excellent reduction of both fractures and
again was irrigated. It was placed in a bulky sterile dressing.
The patient was extubated and transferred to PACU in stable
condition.
The nail bed was intact. However, there was circumferential
laceration over the volar distal interphalangeal joint region.
This communicated with the open distal phalanx fracture.
The most-radial aspect of the base of the distal phalanx was
pulled distally and was attached to the flexor tendon. I
reduced this fragment and pinned it with a K-wire. I then
reduced the contralateral base of the distal phalanx with a
K-wire crossing the distal interphalangeal joint. When I was
finished, I had excellent reduction and a stable fixation.
This, indeed, placed the flexor tendon back into its anatomic
position. The wound, which I did extend, was copiously
irrigated and closed with interrupted 4-0 nylon.
We then turned our attention to the ring finger. There was a
nail bed injury. The nail bed was removed. The complex
laceration was repaired with interrupted 4-0 nylon. The patient
had a displaced distal phalanx fracture which was transverse in
nature. I then was able to place a K-wire across the fracture
site and obtain anatomic alignment of the distal phalanx. C-arm
imaging confirmed excellent reduction of both fractures and
again was irrigated. It was placed in a bulky sterile dressing.
The patient was extubated and transferred to PACU in stable
condition.
