PMC6864336_01
Pre - operative examination showing nearly amputation of right index (Fig. 1A). Radial of digital artery, vein and nerve of index completely tear with the articular surface of metacarpal head fracture (Fig. 1B). The radiographs show fracture dislocation of the head of the second metacarpal with articular involvement fracture 25% in oblique view (Fig. 1C) and AP view (Fig. 1D).
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Examination of his right hand found a dirty shearing cut twelve-centimeter wound on the radial side of the index finger extending to first web space to a point just distal to the metacarpophalangeal joint (MCP) joint, with nearly amputation (Fig. 1A). The nearly amputated segment contained with MCP radial collateral ligament, extensor tendon injury (zone V), radial of digital artery, vein and nerve of index completely tear with the articular surface of metacarpal head fracture (Fig. 1B). The radiographs show fracture dislocation of the head of the second metacarpal with articular involvement fracture 25% (Fig. 1C-D).
Intra-operative collateral ligament complex injury (Fig. 2A) and continuous intraosseous suture which imbedded in the radial side of the metacarpal head (Fig. 2B).
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The collateral ligament was identified as illustration (Fig. 2A). The joint alignment was restored by repair of the conjoined origin of the collateral and accessory collateral ligaments to a continuous intraosseous suture which imbedded in the radial side of the metacarpal head with non-absorbable suture (Ethibond 4-0) (Fig. 2B).
Intra-operative repair collateral ligament complex (Fig. 3A-B) and post - operative showing post-operative x-ray oblique view (Fig. 3C) and AP view (Fig. 3D).
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Skin margin was debrided and the wound was sutured (Fig. 3A-B). Finally, alignment and fixation were checked of all constructs were done under fluoroscope then volar slab was applied in safe position and post-operative x-ray was checked again (Fig. 3C-D).
The radiographs showed the union of intraarticular fracture at 3 month follow up (Fig. 4A) and 1 year follow up (Fig. 4B).
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When he returned to follow up 3 months later show union of intraarticular at fracture site (Fig. 4A). Followed up one year later, the x-ray was showed the union of intraarticular fracture (Fig. 4B) and the sensory was recovered and had the full flexion and extension of MCP but he had minimal, limited extension of proximal interphalangeal joints (PIP) and distal interphalangeal joints (DIP) (Fig. 5).