CASE REPORT

DESEMBER 2014

FINGER TIP INJURY OF LEFT MIDDLE FINGER

ALLEN TYPE IV
Presented by:
Mayanti Virna Patabang C11109371
Advisors:
dr. Edwin William T.
dr. Denal Bato Tampak
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
motorcyles gear .
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
Look

Feel

Wound at the tip of middle finger, size 2x1,5cm, bone exposed (+), deformity
(+), hematome (+), swelling (+)

Tenderness (+), NVD: sensibility is good, pulsation of radial and ulnar artery is
good, CRT < 2

Move

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
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 10/uL

RBC

4,47 x 10/uL

HB

15,0 g/dL

HCT

44,0 %

PLT

272 x 10/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 motorcyles 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

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
injuries include
blunt or crush
injuries to the
fingernail

Burns and frostbite

commonly involve
fingertips

Sharp or shearing
injuries from knives
and glass result in
lacerations and
avulsion types of
soft tissue defects

CLASSIFICATION

Allen type I
Allen type II
Allen type III
Allen type IV

CLASSIFICATION

The angle of injury are shown

CLINICAL PRESENTATION
As certain the following information when
gathering patient history:
Mechanism of injury
Hand dominance
Occupation and hobbies
Length of time since injury
Tetanus immunization status

Evaluate the finger tip injury to determine the

following:
Crush versus sharp injuries
Nail or nail bed involvement
Bone involvement
Viability of tip
Presence of foreign body

TREATMENT

HEALING BY
SECONDARY
INTENTION

This method relies on reepithelialization and contracture to

provide wound closure.
Reserved for small defects (6 to 8 mm) without exposed bone
and with minimal loss of pulp tissue.
Begin treatment with a thorough debridement of the wound.
Perform local wound care two to three times daily with
dressing changes. Healing is usually completed by 3 to 6
weeks depending on the size of the defect.

Regional Flap

Cross-finger
Flap
Thenar and
Thenar-H 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
Contracture

THANK YOU