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Re: Огнестрельное ранение I пальца кисти (gunshot wound of the thumb)
Jeff Brooks 04 Февраль 2009, 22:00
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Hi Danil,
Thanks for sharing this case. I like that fixator you've got on there!
I am very surprised there is no radial digital nerve injury and the FPL is ok. Lucky young lady.
My vote would be for thumb MP fusion with distal radius autograft and fixation of your choice (tension band, accutrak screw, etc). Might
require 3-4mm of shortening but be careful about shortening too much.
That radial side of P1 is gone, as is the dorso-radial metacarpal head. There will be a big hole to fill but I imagine it's do-able.
Just resist the temptation to over-shorten.
Not enough good bone stock to solidly hold any implant in my opinion, and if her CMC and IP joints are mobile and OK she'll do fine with a
fused MP joint. How stiff is that thumb IP joint?
Sincerely,
Jeff
Jeffrey J. Brooks, MD
Stamford, CT
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