Snowblower Injury L Thumb, L Index, L Middle Fingers
L Thumb: Dx
1. Open wound Radial aspect near IP joint with open avulsion injury of bone DP (2.0 cm vertical laceration)
L Thumb: Procedure
1. Exploration digit under 3.3 x loupe magnifiction
2. Debridement and curettage bone
3. Copious lavage soft tissue c pulse lavage
4. Closure wound
L Index: Diagnosis
1. crush injury with
2. open wound volar zone 2 with step lacerations severe soft tissue injury and avulsion and displacement soft tissues external to skin (4.0 + 2.5 cm laceration = 6.5 cm open wounds volar zone 2) and (1.5 cm oblique laceration dorsum P1 zone 4)
3. open wound dorsum oblique c extensor tendon laceration zone 4
4. open fx bone proximal phalanx (P1) comminuted c bone defect and displaced bone pieces
5. decreased sensation ulnar aspect of digit
L Index: Procedure
1. Exploration digit under 3.3 x loupe magnification
2. Copious lavage soft tissue
3. Extensive debridement soft tissues (sharp debridement)
4. Exploration bilateral digital nerves, neurolysis and inspection
5. Exploration dorsum P1 for ORIF fracture (5.5 cm staight line access)
6. Debridement and curettage bone/open comminuted fracture
7. ORIF proximal phalanx c C-arm guidance using 2 x .035 K-wires
8. Hydroset Injectable HA Bone Substitute to fill bone defect and enable onlay of small comminuted bone piece
9. Repair extensor mechanism inury zone 4
10. Complex volar wound repair 6.5 cm including replacement/repostionoing avulsed displaced soft tissues externalized from trauma
11. Repair dorsal wound (6.0 cm curvillinear wound including in continuity open traumatic oblique wound)
L Middle: Diagnosis
1. crush injury with
2. open wound x 2 oblique volar aspect proximal phalanx (5.5. + 2.5 = 8.0 cm)
3. open fracture oblique shaft P1 comminuted
4. decreased sensation radial aspect of digit
5. laceration radial slip FDS tendon
L Middle finger: Procedure
1. Exploration digit under 3.3 x loupe magnification
2. Copious pulse lavage soft tissue
3. Extensive debridement soft tissues (sharp debridement)
4. Exploration bilateral digital nerves, neurolysis and inspection
5. Repair Radial digital slip flexor FDS tendon zone 2
6. Exploration dorsum P1 for acces for ORIF of fracture (5 cm staight line incision)
7. Debridement and curettage bone/open comminuted fracture
8. ORIF proximal phalanx c C-arm guidance using 2 x .035 K-wires
9. Complex wound closure volar wounds 8.0 cm
10. Closure dorsal wound 5 cm
Volar fiberglass short-arm splint
TT: 119 min @ 250 mm Hg (17:39 - 19:38)
Down: 28 min (19:38 - 20:06)
Up: 73 min (20:06 - 21:19)
L Thumb: Dx
1. Open wound Radial aspect near IP joint with open avulsion injury of bone DP (2.0 cm vertical laceration)
L Thumb: Procedure
1. Exploration digit under 3.3 x loupe magnifiction
2. Debridement and curettage bone
3. Copious lavage soft tissue c pulse lavage
4. Closure wound
L Index: Diagnosis
1. crush injury with
2. open wound volar zone 2 with step lacerations severe soft tissue injury and avulsion and displacement soft tissues external to skin (4.0 + 2.5 cm laceration = 6.5 cm open wounds volar zone 2) and (1.5 cm oblique laceration dorsum P1 zone 4)
3. open wound dorsum oblique c extensor tendon laceration zone 4
4. open fx bone proximal phalanx (P1) comminuted c bone defect and displaced bone pieces
5. decreased sensation ulnar aspect of digit
L Index: Procedure
1. Exploration digit under 3.3 x loupe magnification
2. Copious lavage soft tissue
3. Extensive debridement soft tissues (sharp debridement)
4. Exploration bilateral digital nerves, neurolysis and inspection
5. Exploration dorsum P1 for ORIF fracture (5.5 cm staight line access)
6. Debridement and curettage bone/open comminuted fracture
7. ORIF proximal phalanx c C-arm guidance using 2 x .035 K-wires
8. Hydroset Injectable HA Bone Substitute to fill bone defect and enable onlay of small comminuted bone piece
9. Repair extensor mechanism inury zone 4
10. Complex volar wound repair 6.5 cm including replacement/repostionoing avulsed displaced soft tissues externalized from trauma
11. Repair dorsal wound (6.0 cm curvillinear wound including in continuity open traumatic oblique wound)
L Middle: Diagnosis
1. crush injury with
2. open wound x 2 oblique volar aspect proximal phalanx (5.5. + 2.5 = 8.0 cm)
3. open fracture oblique shaft P1 comminuted
4. decreased sensation radial aspect of digit
5. laceration radial slip FDS tendon
L Middle finger: Procedure
1. Exploration digit under 3.3 x loupe magnification
2. Copious pulse lavage soft tissue
3. Extensive debridement soft tissues (sharp debridement)
4. Exploration bilateral digital nerves, neurolysis and inspection
5. Repair Radial digital slip flexor FDS tendon zone 2
6. Exploration dorsum P1 for acces for ORIF of fracture (5 cm staight line incision)
7. Debridement and curettage bone/open comminuted fracture
8. ORIF proximal phalanx c C-arm guidance using 2 x .035 K-wires
9. Complex wound closure volar wounds 8.0 cm
10. Closure dorsal wound 5 cm
Volar fiberglass short-arm splint
TT: 119 min @ 250 mm Hg (17:39 - 19:38)
Down: 28 min (19:38 - 20:06)
Up: 73 min (20:06 - 21:19)