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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

Clinical photographs (a,b,e,f) and X-rays anteroposterior view (c,d) shows (a) A 35-year-old patient with sharp injury through the nail. (b) Vertical figure-of-eight suture placed dorsally over the nail. (c) Fractured distal phalanx. (d) Healed distal phalanx at 2 years. (e and f) Clinically stable fingertip at 2 years
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Figure 3: Clinical photographs (a,b,e,f) and X-rays anteroposterior view (c,d) shows (a) A 35-year-old patient with sharp injury through the nail. (b) Vertical figure-of-eight suture placed dorsally over the nail. (c) Fractured distal phalanx. (d) Healed distal phalanx at 2 years. (e and f) Clinically stable fingertip at 2 years

Mentions: We did not use any intramedullary fixation for fracture stabilization as the dorsal tension band suture with replaced nail plate acted as the dorsal splint and, coupled with the intact soft tissue on the opposite (volar) side, gave sufficient stability to the fracture fragments and the fingertip. Even the cases of sharp injury through the nail plate were treated similarly by just approximating the nail edges together and placing the dorsal tension band suture over it [Figure 3a–f]. Operating time was noted in each case.


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

Memon FW - Indian J Orthop (2012)

Clinical photographs (a,b,e,f) and X-rays anteroposterior view (c,d) shows (a) A 35-year-old patient with sharp injury through the nail. (b) Vertical figure-of-eight suture placed dorsally over the nail. (c) Fractured distal phalanx. (d) Healed distal phalanx at 2 years. (e and f) Clinically stable fingertip at 2 years
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Clinical photographs (a,b,e,f) and X-rays anteroposterior view (c,d) shows (a) A 35-year-old patient with sharp injury through the nail. (b) Vertical figure-of-eight suture placed dorsally over the nail. (c) Fractured distal phalanx. (d) Healed distal phalanx at 2 years. (e and f) Clinically stable fingertip at 2 years
Mentions: We did not use any intramedullary fixation for fracture stabilization as the dorsal tension band suture with replaced nail plate acted as the dorsal splint and, coupled with the intact soft tissue on the opposite (volar) side, gave sufficient stability to the fracture fragments and the fingertip. Even the cases of sharp injury through the nail plate were treated similarly by just approximating the nail edges together and placing the dorsal tension band suture over it [Figure 3a–f]. Operating time was noted in each case.

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