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40 years old gentleman alleged cut his left hand with parang while doing some farm work. This picture of hand is taken while asking the patient to extend his fingers
1) Describe your findings
2) What is your spot diagnosis
3) Management for this patient
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| The anatomy of the Extensor Tendon of the hand |
Answer
1) Findings
- oblique laceration wound at the dorsum of hand extending from base of ring finger to opposite of index finger
- index and middle finger in flexion position / inability to extend the index and middle finger
2) Deep laceration wound with cut of extensor digitorum of left index and middle finger
3) Management
- Wound irrigation
- Pain management (IV Tramadol/ NSAIDs-Paracetamol)
- IV Antibiotic covering gram positive, negative and anaerobs
- Anti tetanous Toxoid injection.
- Hand X Ray -Oblique and AP to exclude any bony involvement
- Full blood count for Hb level. Patient may need blood transfusion if anemia secondary to blood loss. TWBC count may be a helpful marker for infection. Coagulation profile may be helpful if suspected any clotting disorder.
- Hand X Ray -Oblique and AP to exclude any bony involvement
- Full blood count for Hb level. Patient may need blood transfusion if anemia secondary to blood loss. TWBC count may be a helpful marker for infection. Coagulation profile may be helpful if suspected any clotting disorder.
- Wound exploration, debridement and tendon repair
- Thermosplint with hand in extension position for three weeks followed with hand exercise (Flexion-extension of fingers)
Very well kept blog. Keep up the good work. I saw a same case in orthopaedic posting 2months ago.
ReplyDeletelaceration = blunt injury. parang = blunt?
ReplyDeletei have the same injury, but on right hand..my dominant hand...severed two nicked two..pointer finger, middle finger..repaired in ER...10 days in bandages..2 1/2 weeks in cast..2 1/2 weeks in splint..started PT today...PT hurts way worse then laceration..hope full range and power comes back..very weak
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