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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

Immediately postoperative, a hard splint is applied well beyond the fingertip to protect the operated finger from direct trauma
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Figure 4: Immediately postoperative, a hard splint is applied well beyond the fingertip to protect the operated finger from direct trauma

Mentions: Postoperatively, the fingertip was observed for distal vascularity. Once the vascularity of fingertip was confirmed, dressing was applied with hard splint that was well beyond the tip so as to avoid any direct trauma to the operated fingertip [Figure 4]. Dressing was done after 48 hours and at 5 days postoperatively. The hard splint was removed at 5 days and the dressing was removed when the fingertip appeared dry and healed, usually at 2 weeks. The figure of eight suture was removed at 6 weeks or when the fingertip is stable enough to maintain the fracture reduction. Radiological evidence of fracture healing is not necessary for removal of the figure-of-eight suture. Finger was mobilized at 6 weeks and pinch grip was started.


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

Memon FW - Indian J Orthop (2012)

Immediately postoperative, a hard splint is applied well beyond the fingertip to protect the operated finger from direct trauma
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Immediately postoperative, a hard splint is applied well beyond the fingertip to protect the operated finger from direct trauma
Mentions: Postoperatively, the fingertip was observed for distal vascularity. Once the vascularity of fingertip was confirmed, dressing was applied with hard splint that was well beyond the tip so as to avoid any direct trauma to the operated fingertip [Figure 4]. Dressing was done after 48 hours and at 5 days postoperatively. The hard splint was removed at 5 days and the dressing was removed when the fingertip appeared dry and healed, usually at 2 weeks. The figure of eight suture was removed at 6 weeks or when the fingertip is stable enough to maintain the fracture reduction. Radiological evidence of fracture healing is not necessary for removal of the figure-of-eight suture. Finger was mobilized at 6 weeks and pinch grip was started.

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