Limits...
Results of vertical figure-of-eight tension band suture for finger nail disruptions with fractures of distal phalanx.

Memon FW - Indian J Orthop (2012)

Bottom Line: We also evaluated our results based on visual analogue scale for pain and range of motion of distal interphalangeal joint.Two sutures had to be revised due to over tensioning and subsequent vascular compromise within minutes of repair; however, this did not affect the final outcome.This technique is simple, secure, and easily reproducible.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India.

ABSTRACT

Background: Fingertip injuries involve varying degree of fractures of the distal phalanx and nail bed or nail plate disruptions. The treatment modalities recommended for these injuries include fracture fixation with K-wire and meticulous repair of nail bed after nail removal and later repositioning of nail or stent substitute into the nail fold by various methods. This study was undertaken to evaluate the functional outcome of vertical figure-of-eight tension band suture for finger nail disruptions with fractures of distal phalanx.

Materials and methods: A series of 40 patients aged between 4 and 58 years, with 43 fingernail disruptions and fracture of distal phalanges, were treated with vertical figure-of-eight tension band sutures without formal fixation of fracture fragments and the results were reviewed. In this method, the injuries were treated by thoroughly cleaning the wound, reducing the fracture fragments, anatomical replacement of nail plate, and securing it by vertical figure-of-eight tension band suture.

Results: All patients were followed up for a minimum of 3 months. The clinical evaluation of the patients was based on radiological fracture union and painless pinch to determine fingertip stability. Every single fracture united and every fingertip was clinically stable at the time of final followup. We also evaluated our results based on visual analogue scale for pain and range of motion of distal interphalangeal joint. Two sutures had to be revised due to over tensioning and subsequent vascular compromise within minutes of repair; however, this did not affect the final outcome.

Conclusion: This technique is simple, secure, and easily reproducible. It neither requires formal repair of injured nail bed structures nor fixation of distal phalangeal fracture and results in uncomplicated reformation of nail plate and uneventful healing of distal phalangeal fractures.

No MeSH data available.


Related in: MedlinePlus

A clinical photograph (a-d and g) and X-rays (e,f) (lateral view) shows (a) Proximal nail plate avulsion with laceration of the nail fold. (b) The suture is placed transversely proximal to the wound such as to avoid injury to the germinal matrix. (c) The distal suture is taken through the tip of the finger pulp by crossing over the repositioned nail to cause vertical figure-of-eight loop. (d) Completed suture over dorsum of fingertip over the nail with adequate tension. (e and f) The fracture of distal phalanx that was reduced without formal internal fixation healed without any deformity. (g) Clinically stable fingertip at 3 months followup
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3377148&req=5

Figure 2: A clinical photograph (a-d and g) and X-rays (e,f) (lateral view) shows (a) Proximal nail plate avulsion with laceration of the nail fold. (b) The suture is placed transversely proximal to the wound such as to avoid injury to the germinal matrix. (c) The distal suture is taken through the tip of the finger pulp by crossing over the repositioned nail to cause vertical figure-of-eight loop. (d) Completed suture over dorsum of fingertip over the nail with adequate tension. (e and f) The fracture of distal phalanx that was reduced without formal internal fixation healed without any deformity. (g) Clinically stable fingertip at 3 months followup

Mentions: Under digital block for adults and general anesthesia for children was done thorough cleaning and draping of the affected hand. The nail plate with its residual attachment, if any, was preserved. Without removing it, the undersurface was thoroughly cleaned by syringe jet and hematoma evacuated. If the fracture fragments were seen, they were reduced under vision. If the nail was completely avulsed, it was cleaned thoroughly. The nail was then repositioned in its eponychial fold anatomically and secured in place with vertical figure-of-eight tension band suture opposite to the intact soft tissue of the injured fingertip, usually on the dorsal aspect, with 3-0 nylon sutures in adults and 4-0 nylon sutures on cutting needle tip in children. Proximally, the suture was placed transversely through the skin such as to avoid injury to the germinal matrix of the nail [Figure 2a and b]. Then, the distal suture is taken through the tip of finger pulp by crossing over the repositioned nail plate to cause the figure-of-eight loop [Figure 2c]. Now, while maintaining the position of the nail plate, the knot was tied, resulting in figure-of-eight tension band suture [Figure 2d]. The tension given to the loop was adequate enough to maintain reduction [Figure 2e and f]; however, at the same time, it was not compromising the distal vascularity of the fingertip. Try and approximate the lateral skin edges with the same loop to avoid additional insult to the already injured tissue. However, if the need arises, one can take a simple suture for the same.


Results of vertical figure-of-eight tension band suture for finger nail disruptions with fractures of distal phalanx.

Memon FW - Indian J Orthop (2012)

A clinical photograph (a-d and g) and X-rays (e,f) (lateral view) shows (a) Proximal nail plate avulsion with laceration of the nail fold. (b) The suture is placed transversely proximal to the wound such as to avoid injury to the germinal matrix. (c) The distal suture is taken through the tip of the finger pulp by crossing over the repositioned nail to cause vertical figure-of-eight loop. (d) Completed suture over dorsum of fingertip over the nail with adequate tension. (e and f) The fracture of distal phalanx that was reduced without formal internal fixation healed without any deformity. (g) Clinically stable fingertip at 3 months followup
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3377148&req=5

Figure 2: A clinical photograph (a-d and g) and X-rays (e,f) (lateral view) shows (a) Proximal nail plate avulsion with laceration of the nail fold. (b) The suture is placed transversely proximal to the wound such as to avoid injury to the germinal matrix. (c) The distal suture is taken through the tip of the finger pulp by crossing over the repositioned nail to cause vertical figure-of-eight loop. (d) Completed suture over dorsum of fingertip over the nail with adequate tension. (e and f) The fracture of distal phalanx that was reduced without formal internal fixation healed without any deformity. (g) Clinically stable fingertip at 3 months followup
Mentions: Under digital block for adults and general anesthesia for children was done thorough cleaning and draping of the affected hand. The nail plate with its residual attachment, if any, was preserved. Without removing it, the undersurface was thoroughly cleaned by syringe jet and hematoma evacuated. If the fracture fragments were seen, they were reduced under vision. If the nail was completely avulsed, it was cleaned thoroughly. The nail was then repositioned in its eponychial fold anatomically and secured in place with vertical figure-of-eight tension band suture opposite to the intact soft tissue of the injured fingertip, usually on the dorsal aspect, with 3-0 nylon sutures in adults and 4-0 nylon sutures on cutting needle tip in children. Proximally, the suture was placed transversely through the skin such as to avoid injury to the germinal matrix of the nail [Figure 2a and b]. Then, the distal suture is taken through the tip of finger pulp by crossing over the repositioned nail plate to cause the figure-of-eight loop [Figure 2c]. Now, while maintaining the position of the nail plate, the knot was tied, resulting in figure-of-eight tension band suture [Figure 2d]. The tension given to the loop was adequate enough to maintain reduction [Figure 2e and f]; however, at the same time, it was not compromising the distal vascularity of the fingertip. Try and approximate the lateral skin edges with the same loop to avoid additional insult to the already injured tissue. However, if the need arises, one can take a simple suture for the same.

Bottom Line: We also evaluated our results based on visual analogue scale for pain and range of motion of distal interphalangeal joint.Two sutures had to be revised due to over tensioning and subsequent vascular compromise within minutes of repair; however, this did not affect the final outcome.This technique is simple, secure, and easily reproducible.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India.

ABSTRACT

Background: Fingertip injuries involve varying degree of fractures of the distal phalanx and nail bed or nail plate disruptions. The treatment modalities recommended for these injuries include fracture fixation with K-wire and meticulous repair of nail bed after nail removal and later repositioning of nail or stent substitute into the nail fold by various methods. This study was undertaken to evaluate the functional outcome of vertical figure-of-eight tension band suture for finger nail disruptions with fractures of distal phalanx.

Materials and methods: A series of 40 patients aged between 4 and 58 years, with 43 fingernail disruptions and fracture of distal phalanges, were treated with vertical figure-of-eight tension band sutures without formal fixation of fracture fragments and the results were reviewed. In this method, the injuries were treated by thoroughly cleaning the wound, reducing the fracture fragments, anatomical replacement of nail plate, and securing it by vertical figure-of-eight tension band suture.

Results: All patients were followed up for a minimum of 3 months. The clinical evaluation of the patients was based on radiological fracture union and painless pinch to determine fingertip stability. Every single fracture united and every fingertip was clinically stable at the time of final followup. We also evaluated our results based on visual analogue scale for pain and range of motion of distal interphalangeal joint. Two sutures had to be revised due to over tensioning and subsequent vascular compromise within minutes of repair; however, this did not affect the final outcome.

Conclusion: This technique is simple, secure, and easily reproducible. It neither requires formal repair of injured nail bed structures nor fixation of distal phalangeal fracture and results in uncomplicated reformation of nail plate and uneventful healing of distal phalangeal fractures.

No MeSH data available.


Related in: MedlinePlus