Concluded Case

Destructive injury

45yrs m came with h/o crash injury in MASALA GRINDER at work outfit yesterday afternoon nondiabetic nonhypertensive hospitalised and procedures were carried out by a team for 9pm to 1pm your suggestions future update will be given

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Bad injury. Clinically what is the status of flexor tendons, digital nerves and arteries? How is the distal sensation, capillary filling, spO2? Is there bleeding on pin prick at finger tips? High risk of superficial and deep palmar arterial arch laceration looking at level of injury. Neurovascular is first priority. If neurovascular status is ok, after debridement, bony stabilization can be done with JESS fixator to get the alignment. May not be possible to salvage 2nd metacarpal, very badly comminuted head. Explain to pt regarding stiffness, loss of function of hand. Please keep updated regarding status. Thank you.

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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Thank you Sir for nice posting Very complicated crush fracture of hands of 4 MC Pressure bandage with splint & refer to Orthopaedic Surgeon as early as possible for operations, plan will be taken, may require pin, screw, wire whatever Surgeon required. Repaire of tendon, vessels is required.

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Bad injury. Clinically what is the status of flexor tendons, digital nerves and arteries? How is the distal sensation, capillary filling, spO2? Is there bleeding on pin prick at finger tips? High risk of superficial and deep palmar arterial arch laceration looking at level of injury. Neurovascular is first priority. If neurovascular status is ok, after debridement, bony stabilization can be done with JESS fixator to get the alignment. May not be possible to salvage 2nd metacarpal, very badly comminuted head. Explain to pt regarding stiffness, loss of function of hand. Please keep updated regarding status. Thank you.

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Assess severity of neurovascular injury and distal circulation Need debridement: tendon repair: vascular repair if injury is there K wire fixation of features Volar pop slab in functional position for six weeks May need secondary procedures

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COMPLICATED... UNFAVOURABLE... CRUSH. FRACTURE.. ....... FOUR. METACARPALS.... ADVISABLE... ,,,,, OPEN. SURGERY.... ...... REDUCTION AND. FIXATION ..... EXPERIENCED..... ORTHOPEDIC ..... WORK..... REQUIRED

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Fracture all metatarsal do flexion & extension to know tendon damage orthopaedics hand surgeon reference let me know prognosis dont put any powder only tight bandage send to center

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# of 4 metacarpals bone . Open surgery with wiring required. Pl inform about prognosis.

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First secure the arterial supply to the hand. Nerve injury then and then debridement. Reconstructive surgery accordingly to help the movement. God Bless to the fellow

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Agree with Dr.Shrivastava N

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Crush fracture of 4 metacarpals K wiring Ref to orthopedician

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