Presentation
Left hand crushed by boulder. Open wounds to dorsum over MCPJs and index PIPJ.
Patient Data
Comminuted fractures of left index, middle and ring finger proximal phalanxes. Index finger fracture has significant volar angulation. Minimally displaced longitudinal fracture of middle phalanx of third digit. No articular involvement.
No other bony injuries.
Significant soft tissue swelling. No radioopaque foreign bodies.
Case Discussion
This patient has had a signficant crush injury to the left hand. IV antibiotics, washout, immobilsation and elevation are initial measures that can be taken. Assessment of the neurovascular status of the affected digits and any obvious tendon involvement should be documented. Further management should be with orthopedics or specialist hand centers (this case involved decompression of the carpal tunnel and K-wire fixation of the proximal phalangeal fractures).
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