Date: Mon, 21 Feb 2000 16:13:35 +0500
Subject: Hand - Propeller Injury
One more case, a patient (male, 32 years old) from a hand surgery unit of another hospital - a real telemedicine goes here ;-)
A right hand of the patient was damaged 11 Feb 2000 by a propeller of air-vehicle. In the hospital they performed debridement and stabilized remained fingers by ex-fix.
I attached x-rays and some photos of the hand. The patient wants to visit a hand surgery clinic abroad. So your opinion is requested about is it worth to search for other treatment modalities for this case, if yes - what reconstruction can be done in this case and what clinic should he admit for best care. As i realize he has enough money to pay for the trip and treament. THX in advance.
Best regards, Alexander N. Chelnokov, Ural Scientific Institute of Traumatology and Orthopaedics 7, Bankovsky str. Ekaterinburg 620014 Russia
Date: Wed, 23 Feb 2000 09:47:32 -0700
From: Thomas A. DeCoster M.D.
I have reviewed the hand case with my colleague here at the University of New Mexico, Dr. Yi.
By way of clarification, this appears to be the case of a severe propeller injury to the right hand with open fractures of the digits and complex lacerations to the palm.
It appears to have been treated with shortening of the residual fourth and fifth rays to the metacarpal shaft level presumably to obtain soft tissue coverage. The thumb was treated with pinning of the proximal and distal phalanx fractures and metacarpal shaft fracture with an outrigger external fixator. The long and ring fingers were also incorporated into the outrigger external fixator. The soft tissue dorsally appears OK and there is coverage on the palmar side.
Further questions: What is the status of the tendons, flexor and extensor, to remaining digits?
Recommendation at this time (if tendons intact) to start early aggressive ROM because stiffness is a much more difficult problem to overcome than nonunion of fracture and hand mobility is of prime importance. Would NOT attempt reconstruction of fourth and fifth fingers or any sort of toe to hand transfer. Timing of ROM dependent upon soft tissue healing but would start some thenar motion now with current fixation and splintage to maintain web space because the palmar wound will tend to contract. Aggressive ROM by 4 weeks. Edema control by elevation, compressive wrap may help healing and ROM.
Out of country referral seems unlikely to result in any major change in treatment.
IN SOK YI