20230811 Fingertip injury - Dr Low JW

A 20-year-old gentleman got his finger stuck between a metal door. A clinical picture and radiograph of his injury are as shown above. Which of the following is the most appropriate management for his injuries?

• Observation and analgesia only.

• Trephination and drainage of hematoma.

• Nail plate removal and irrigation.

• Nail plate removal, irrigation, nail bed repair and occlusive dressing.

• Nail plate removal, irrigation, nail bed repair and replace with native nail.

A 28-year-old factory worker has his ring finger caught in the machinery at work. A photograph of the injury is shown in Figure A. Which of the following procedures will best supply coverage of the wound?

• Amputation through the proximal interphalangeal joint

• Shortening of the distal phalanx, nail bed removal, and V-Y flap

• Cross-finger flap

• Groin flap

• Thenar flap

You are planning on performing the flap reconstruction depicted in Figure A. What injury pattern and patient characteristics best match the indication for this reconstruction technique?

• 66-year-old male with a volar oblique defect of the long finger

• 23-year-old female with a dorsal oblique defect of the long finger

• 29-year-old female with rheumatoid arthritis and a volar oblique defect of the index finger

• 45-year-old male laborer with a volar thumb tip defect

• 28-year-old male with a volar oblique defect of the index finger

A 32-year-old man sustains an injury to his left thumb. Examination in the ER demonstrates a 2 x 4 cm wound on the dorsal thumb overlying the proximal phalanx with exposed tendon and bone. What is the most appropriate option for soft tissue coverage?

• Cross-finger flap

• Moberg advancement flap

• Full-thickness skin graft

• First dorsal metacarpal artery flap

• V-Y advancement flap

Which if the following complication is most likely to occur following the procedure shown above?

• Cosmetic mismatch of skin

• Recurrent motor branch of median nerve injury

• Flap failure

• Flexion contracture at recipient PIPJ

• Hook nail deformity