DIAGNOSIS: Open complex dislocation to the left fourth digit involving volar plate collateral ligaments with near total avulsion of the fingertips with involvement of the digital nerves.
OPERATION PERFORMED
1.Open irrigation and debridement including removal of foreign material, devitalized soft tissue extending down to tendinous structures involving open complex dislocation.
2.Repair of ulnar collateral ligament.
3.Repair of radial collateral ligament.
4.Repair of radial digital nerve.
5.Repair of ulnar digital nerve.
6.Repair of volar plate of interphalangeal joint.
INDICATIONS FOR OPERATION: This patient is status post a very complex dislocation in which he nearly totally avulsed his finger and due to extensive ligament tendon injuries he was sent for a specialist consultation. This was much more complex than a normal tendon or ligament repair, which is often done by emergency room physicians. The patient was referred by ____[CLINIC].
This patient’s occupation is construction, and on this date, he did have a very large piece of concrete fall on him, severing and causing a near avulsion, open dislocation, of which his finger bent over backwards completely with the bone protruding and only connected by some soft tissue, nearly completely ripping all the ligamentous structures of the interphalangeal joint.
OPERATION IN DETAIL: After sterile preparation and draping in the normal fashion, and a regional digital block anesthesia, tourniquet exsanguination of the fingers, the digit was approached. The collateral ligaments were repaired using 4-0 PDS suture. The wound was also cleansed and irrigated copiously using antibiotic saline solution. Removal of foreign body, devitalized, crushed soft tissue was done for the open complex dislocation. The patient also had near complete amputation. There were 2 significant sized digital nerve branches, which were repaired under magnification using an epineural repair using micro technique and micro instruments and they were my own microinstruments.
However, prior to this, the patient also had disruptions of the volar plate. This is thought to be one of the main causes of the patient having no flexion of the digit and minimal movement.
The volar plate was repaired after using PDS suture. The profundus tendon was examined and found to be intact. It required no repair other than the surrounding structures around it. The patient did regain some movement after this; however, did not have forward flexion. He did have function of his extensor tendon and it was thought that part of the flexor belly was in spasm; however, the proximal and distal portions of the flexor tendon were intact upon extensive traction of the area prior to the repair of the previous mentioned structures.
Detailed instructions and appropriate dressings were used for the patient with followup discussed with the patient. He was also under the instruction that he should be very careful, keep his finger splinted at all times, and we will start him on a hand rehabilitation regimen, which will take months before he is able to have fairly normal function of the digit and it will not be back near its normal strength for 4 to 6 months.
