CASE REPORT

JANUARY 2015

FINGER TIP INJURY OF LEFT MIDDLE FINGER

ALLEN TYPE IV

Presented by:
Mayanti Virna Patabang C11109371

Advisors:
dr. Felix Sander Batuna
dr. Edwin William T.

Supervisor:
dr. Henry Yurianto, M.Phil, Ph.D, Sp.OT
ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT
MEDICAL FACULTY
HASANUDDIN UNIVERSITY
 IDENTITY
• Name : Mr. AM
• Age : 23 y.o
• Gender : Male
• Registration : 691931
• Admission : December 7th, 2014
 AUTOANAMNESIS
Chief complain: wound at left middle finger
• Suffered since 30 minutes ago before admitted to
Wahidin General Hospital.
• Patient was repairing his motorcycle, and
accidentally his left middle finger trapped into
motorcyle’s gear .
• There is no history of prior treatment.
• Patient is a mechanic and right handed dominant.
 PRIMARY SURVEY
A : Clear
B : RR=20x/min, simetris, spontaneous,
thoracoabdominal type
C : BP=120/80 mmHg, HR=80x/min, strong,
regular
D : GCS 15 (E4M6V5), pupil isochoric, diameter
2,5 mm/2,5 mm, light reflex +/+
E : T=36,7oC (axilla)
 SECONDARY SURVEY
Regio Left Hand

• Wound at the tip of middle finger, size 2x1,5cm, there is bone exposed,
there is deformity, there is hematome, there is swelling
Look

• There is tenderness, NVD: sensibility is good, pulsation of radial and

ulnar artery is good, CRT < 2”
Feel

• Active and passive movement of the wrist joint normal

• Active and passive movement of the MCP and IP joint of the middle
finger are normal
Move • Active and passive movement of the MCP, PIP and DIP joint of the
thumb, index, ring, and little finger are normal
CLINICAL FINDINGS
RADIOLOGY FINDINGS
X-Ray manus sinistra AP/Oblique
LABORATORY FINDINGS
07/12/2014

WBC 11,1 x 10³/uL

RBC 4,47 x 10⁶/uL
HB 15,0 g/dL
HCT 44,0 %
PLT 272 x 10³/uL
CT 6'00"
BT 2'30"
 RESUME
• Male, 23 y.o, came to the hospital with wound at left middle finger,
suffered since 30 minutes ago before admitted to Wahidin General
Hospital. Patient was repairing his motorcycle, and accidentally his
left middle finger trapped into motorcyle’s gear. History of prior
treatment (-). Patient is a mechanic and right handed dominant.
• From physical examination: wound at the tip of middle finger, size
2x1,5cm, bone exposed (+), deformity (+), hematome (+), swelling
(+). From palpation, tenderness can be felt.
• Radiological findings: there is bone loss at tip of distal phalanx of
the left middle finger.
 DIAGNOSIS
Finger tip injury of left middle finger,
Allen type IV
 MANAGEMENT
• Antibiotic
• Analgesic
• Tetanus toxoid
• Debridement + open wound care
• Plan for wound closure
DISCUSSION
ANATOMY
 INTRODUCTION
• Fingertip injuries are defined as those
injuries occurring distal to the insertion of
the flexor and extensor tendons.
• They are the most common injuries of the
hand and can lead to a significant functional
and cosmetic deficit if they are not treated
appropriately.
 EPIDEMIOLOGY
About 10% of all accidents encountered in the ED involve the hand. 

Hand injuries represent 11-14% of on-the-job injuries and 6% of

compensation paid injuries.

Damage to the nail bed is reported to occur in 15-24% of fingertip injuries.

Injury to the fingertip, is common, especially in young men who perform

manual labor.
 ETIOLOGY
Common types of Sharp or shearing
injuries include injuries from knives
blunt or crush and glass result in
injuries to the lacerations and
fingernail avulsion types of
soft tissue defects

Burns and frostbite

commonly involve
fingertips
CLASSIFICATION

• Allen type I
• Allen type II
• Allen type III
• Allen type IV
 CLASSIFICATION

The angle of injury are shown

Information when gathering patient history:
• Mechanism of injury
• Hand dominance
• Occupation and hobbies
• Length of time since injury
• Tetanus immunization status
TREATMENT
HEALING ●
This method relies on reepithelialization and
BY ●
contracture to provide wound closure.
Reserved for small defects (6 to 8 mm) without
SECONDA ●
exposed bone and with minimal loss of pulp tissue.
Begin treatment with a through debridement of the
RY ●
wound.
Perform local wound care two to three times daily
INTENTIO with dressing changes. Healing is usually completed
by 3 to 6 weeks depending on the size of the defect.
N
 Regional Flap
Local Flap
Atasoy-Kleinert Cross-finger
V-Y Flap Flap
Kutler Lateral V- Thenar and
Y Flap Thenar-H Flap

Moberg Flap Island Flap

Atasoy-Kleinert V-Y Flap
Atasoy-Kleinert V-Y Flap
Kutler Lateral V-Y Flap
Thenar Flap
Thenar Flap
 COMPLICATION
• Nail ridge
• Split nails
• Hook nail deformities
• Cold intolerance
THANK YOU