PRESENTED AS CLINICAL ASSIGNMENTIN ORTHOPAEDY AND TRAUMATOLOGY DEPARTMENT MEDICAL FACULTY OF HASANUDDIN UNIVERSITYMAKASSAR2014PREPARED BY:Nor Hazirah Binti OmarC 111 09 846ADVISOR:dr. Alfa Januar dr. Satria Prawira PutraCONSULTANT:dr. Muhammad Sakti, Sp.OT

FINGER TIP INJURYORTHOPAEDY AND TRAUMATOLOGY DEPARTMENT CASE REPORT & REFERATMEDICAL FACULTY FEBRUARI 2015HASANUDDIN UNIVERSITY

IDENTITY

Name:SAge:51 years old / MaleAdmission:January 26th, 2015 at 18:00Registration :69 87 31Status:BPJS

AUTOANAMNESIS(at 18:02)Chief Complain : Pain at right handSuffered since 1 day before admitted to Wahidin General Hospital.Patient was turning on a tractor machine when his right hand accidentally get sliced by the flywheel of the engine.Patient is a farmer and right hand dominantPrior treatment at Jeneponto Hospital.

GENERAL STATUS(at 18: 04)Conscious / well-nourishedVital Signs:Blood pressure: 120/70 mmHgPulse rate: 88 x/minRespiratory rate: 18 x/minTemperature: 36.70CNRS : 3

LOCAL STATUS (at 18:06)

Right hand RegionLook:Stitched wound at middle finger, posterior side at the level of middle phalanx, 1,5 cm in lengthStitched wound at ring finger, semicircular at the level of DIP joint, 3 cm in lengthLacerated wound at ring finger, longitudinal, posterior side, 1cmTraumatic amputation at the level of distal phalanx little finger, bone exposedFeel:Tenderness (+)NVD: Sensibility is hypoesthesia at ring finger, normal at middle finger CRT < 2 sec.Move:Active and passive movements of wrist joint are normalActive and passive movements of MCP,IP joint of thumb are normalActive and passive movements of MCP,PIP,DIP joint of index finger and little finger are normalActive and passive movements of MCP, PIP joint of middle are normalActive extension DIP joint of middle finger is absentActive and passive movements of MCP, PIP of ring finger are normalActive extension DIP joint of ring finger is absent.

CLINICAL FINDINGS

CLINICAL FINDINGS

RADIOLOGY FINDINGS (18.30)

RADIOLOGY FINDINGS (18.30)

LABORATORY FINDINGS(at 18.40)WBC: 12.500/ulRBC: 4.530.000/ulHBG: 14 g/dlHCT : 44 %PLT: 278.000/mm3CT: 800BT: 300HBsAg: Non-reactive

PREOPERATIVE DIAGNOSISLacerated Wound at right middle and ring fingerFinger Tip Injury right little finger Allen Type IIISusp.Rupture right 3rd and 4th Extensor digitorum communis tendonSusp. Open dislocation DIP joint right ring finger

MANAGEMENTRinger Lactat InfusionAnalgesicAntibioticAntitetanusReport to Orthopaedic senior, advice:Debridement + Repair TendonApply K-Wire

OPERATION REPORT 1.Patient in supine position by general anestesia2.Disinfection and drapping procedure3. Identification : Traumatic amputation right distal phalanx 5th finger, total rupture extensor digitorum tendon right 3rd finger, total rupture extensor digitorum tendon 4th finger, Open dislocation right DIP joint 4th finger, lacerated wound right middle phalanx 4th finger.4.Rinse the wound with NACl 0,9% 2L

7.Apply K-wire 1.2 mm at 4th finger8. Performed tendon repair tendon of extensor digitorum communis tendon 3rd and 4th finger with UNHAS Suture technique using non-absorbable 3.0 suture8.The irrigation was done with Na Cl 0,9 % and debridement until the wound looked clean9.The wound approximation was done10.The wound was closed with tulle and steril dressing11.Applying volar slab below elbow at right upper limb12.Operation was done

POSTOPERATIVE DIAGNOSISFinger Tip Injury right little finger Allen Type IIITotal Rupture Extensor digitorum tendon right 3rd finger zone IITotal rupture extensor digitorum tendon right 4th finger zone IOpen dislocation right DIP joint of ring fingerLacerated Wound ring finger

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