Results of a vertical figure-of-eight tension band suture for comminuted middle phalanx fracture: Case Report
INITIAL X-RAY FINAL X-RAY
Mechanism of Injury:
In October 2015, Chris sustained a crush injury to his right index finger, resulting in an open comminuted fracture of the middle phalanx. There was no nail bed damage, vascular compromise or nerve damage. Chris was taken to Sandton Clinic and was seen by Dr Juan Marin, Orthopaedic Surgeon. Dr Marin informed Chris that the fracture would need to be fixated with K Wires. Chris would not give consent to the use of K Wires or Plate & Screw Fixation as he wanted to return to sporting activities as soon as possible.
Noval Surgical Procedure:
Dr Marin was aware of the use of a figure of eight tension band suture to stabilise nail bed and distal phalangeal fractures (Memon, 2012, Patanker, 2007, Bristol & Verchere, 2007 and Bindra, 1997) but these sutures were placed dorsally over the skin and nail bed injury. The multi-fragment fracture of the middle phalanx required reduction and internal fixation. Therefore Dr Marin adapted the previously described technique to provide internal fracture fixation by using a K Wire to drill diagonally across the middle phalanx in both directions. A figure-of eight tension band using Fiber Wire 2 was then threaded through the holes drilled by the K wire to internally fixate the fracture.
Chris was referred to Hand Therapy 2 weeks after surgery. An orthosis was applied dorsally to the right index finger to provide support and pain relief. In the absence of K wires, early active mobilisation of the index finger PIP and DIP joints could be performed. Treatment included wound and scar management, active and passive mobilisation of the right index finger and strength re-training. Chris attended 12 hand therapy appointments over a period of 4 months.
Chris can achieve a composite fist, but is unable to make a tight fist die to the scar tissue that is present over the dorsum of the DIPJ. He has regained full functional use of the hand. Grip and pinch strength are normal in the right hand when compared to the left. Chris is very satisfied with the outcome of the intervention and is grateful that his hand surgeon respected his wish to not have K wire fixation and rather applied an innovative technique.
The technique was successful and should be considered in the future management of comminuted fractures of the finger.