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Finger fractures CASE THREAD
COVID has provided many case examples of patients either delaying care or electing less care for their finger fractures than we'd ordinarily recommend
What happens to ugly fractures that don't get an operation?
#medtwitter #foamed #orthotwitter
1/9
COVID has provided many case examples of patients either delaying care or electing less care for their finger fractures than we'd ordinarily recommend
What happens to ugly fractures that don't get an operation?
#medtwitter #foamed #orthotwitter
1/9
Sometimes things end up okay
Even though they don't look okay
This pt was 3 months out and completely satisfied
One key is that his immobilization was minimal
#medtwitter #foamed #orthotwitter
"Don't just do something, stand there"
2/9
Even though they don't look okay
This pt was 3 months out and completely satisfied
One key is that his immobilization was minimal
#medtwitter #foamed #orthotwitter
"Don't just do something, stand there"
2/9
OK but what about this one?
Surely it'll slide or generate a nonunion?
3/9
#medtwitter #foamed #orthotwitter
Surely it'll slide or generate a nonunion?
3/9
#medtwitter #foamed #orthotwitter
Not quite. Patient buddy taped and fx ended up proving to be stable. It healed with abundant callus and pt returned to manual work at 2 mos, satisfied
Not perfect, but it'll improve
An unappealing radiograph alone isn't a surgical indication
4/9
#medtwitter #foamed #orthotwitter
Not perfect, but it'll improve
An unappealing radiograph alone isn't a surgical indication
4/9
#medtwitter #foamed #orthotwitter
How about this one?
A lot going on here. Recent healed 5th MC shaft fx, dorsally angulated but accepted by pt and adapted to.
New intra articular displaced 5th MC head fx.
Can this be treated nonop too?
#medtwitter #foamed #orthotwitter
5/9
A lot going on here. Recent healed 5th MC shaft fx, dorsally angulated but accepted by pt and adapted to.
New intra articular displaced 5th MC head fx.
Can this be treated nonop too?
#medtwitter #foamed #orthotwitter
5/9
I wouldn't recommend it
Displaced intra-articular fractures are v poorly tolerated
These tiny screws did the trick
Shaft fracture was left alone as it was already fully healed
While many finger frxs do OK ignored, others really dont
6/9
#medtwitter #FOAMed #orthotwitter
Displaced intra-articular fractures are v poorly tolerated
These tiny screws did the trick
Shaft fracture was left alone as it was already fully healed
While many finger frxs do OK ignored, others really dont
6/9
#medtwitter #FOAMed #orthotwitter
This pt had a 5 wk old P1 base extra-articular displaced fx upon presentation
+pseudoclawing
Stiff PIP and MP
Weak grip
No longer tender, as it was healed
As you might infer from him having intraop fluoro pics, he did not love it
#medtwitter #foamed #orthotwitter
7/9
+pseudoclawing
Stiff PIP and MP
Weak grip
No longer tender, as it was healed
As you might infer from him having intraop fluoro pics, he did not love it
#medtwitter #foamed #orthotwitter
7/9
By 3 mos, this is a very satisfactory outcome
Plates over phalanges often cause scarring and stiffness
He had some, but not enough that he's going to have the plate removed &/or tenolysis performed
Finger fxs might look easy.
They're not.
#medtwitter #foamed #orthotwitter
8/9
Plates over phalanges often cause scarring and stiffness
He had some, but not enough that he's going to have the plate removed &/or tenolysis performed
Finger fxs might look easy.
They're not.
#medtwitter #foamed #orthotwitter
8/9
OK last one. You try
This one here. Doesn't look too bad does it?
Say it's a dominant small finger
Acute injury
Healthy, active, middle-aged pt
WWYD?
#medtwitter #foamed #orthotwitter
9/9
This one here. Doesn't look too bad does it?
Say it's a dominant small finger
Acute injury
Healthy, active, middle-aged pt
WWYD?
#medtwitter #foamed #orthotwitter
9/9
