fingertip injury left middle finger

1. Patient Name Age, Sex Assessment Planning
Sarjan Muzayyin 14Y, M
- Close Transverse Fracture of Left Distal Radius with Dorsal
Displacement (Frykman I)
- Close Transverse Fracture of Left Distal Ulna with Dorsal
Displacement
- Volar Slab
- Admitted to Inpatient
- ORIF Elective
Lofni Sam Sukma 40Y, F Fingertip Injury of the Left Middle Finger, Allen Zone III
- Antibiotics & ATS
- V-Y Plasty Emergency
Abdul Qahar 53Y, M Left Knee Sprain
- Knee Bandage
- Discharged to Outpatient
Hafni binti Ibrahim Gadeng 50Y, F Low Back Pain post Removal of Spine Implant + Laminectomy L4-L5
- Adequate Analgesics
- Admitted to Inpatient for
Observation
M. Nasir Hasbi 57Y, M Spinal Cord Injury due to Compression Fracture VC4-5, Frankel A
- Admitted to Inpatient
- Posterior Decompression and
Stabilization Elective
Andi Anugrah Putra 19Y, M Right Ankle Sprain
- Ankle Bandage
- Non-Weight Bearing 2 weeks
- Discharged to Outpatient
Maulana Hafidz 18Y, M
- Head Injury GCS 12 due to Traumatic SAH
- Open Fracture of the Right Lateral Femoral Condyle Gustilo-
Anderson 3A
- Close Spiral Fracture of the Right Midshaft Humerus
- Close Oblique Fracture of the Right Proximal Shaft Radius
- Close Spiral Fracture of the Left Midshaft Femur Winquist Hansen
type I
Damage Control Orthopedics
- Antibiotics & ATS
- Skin Traction Left Femur
- U-Slab Right Humerus
- Volar Slab Right Antebrachii
- Debridement & OREF Emergency
- Multiple ORIF Elective
Saturday, February 3rd 2024 dr. Diaz, dr. Mirza, dr. Milzam
#1

2. Patient Name Age, Sex Assessment Planning
Muhammad Huzaivi Sani 18Y, M
- Head Injury GCS 15 due to Traumatic SAH
- Open Comminutive Fracture of the Right Distal Radius-Ulna Gustilo-
Anderson 3A
- Close Comminutive Fracture of the Right Midshaft Femur Winquist
Hansen type III
- Antibiotics & ATS
- Skin Traction Right Femur
- Volar Slab Right Antebrachii
- Debridement & ORIF Antebrachii
Emergency
- ORIF Femur Elective
Ardin 33Y, M
Left Bimaleolar Ankle Fracture Weber A, Lauge-Hansen Supination-
Adduction
- Below Knee Backslab
- ORIF Elective
Isman Harahap 44Y, M Symphisiolysis due to Pelvic Ring Injury APC-II
- Pelvic Binder
- ORIF Elective
Saturday, February 3rd 2024 dr. Diaz, dr. Mirza, dr. Milzam
#2

3. Lofni Sam Sukma/F/40YO
Fingertip Injury of the Left Middle Finger Allen Zone III/Tamai Zone I
Performed :
V-Y Plasty
(Saturday, February 3rd 2024)
dr. Diaz, dr. Mirza, dr. Milzam

4. History
Chief complaint : Open Wound at the Left Hand
The patient came to the ER with open wounds on the left middle and ring finger following Motorcycle MVA 45
minutes prior to hospital admission. Her left hand was stuck under motorcycle. After evacuation, there is an
amputated stump on his left middle finger with significant loss of skin, pulp, and nail bed with bone exposed. The
distal stump was unrecoverable.
History of past illness : (-)
History of last medication : (-)
History of allergy : (-)

5. Present State
Sens: E4M6V5
BP: 135/90 mmHg
HR: 92 x/min
RR: 18 x/min
T: 36,5oC
General State
•Head
• Eye : Pupil isochor equal 2mm/2mm, sclera normal,
conjunctiva normal
• Nose : normal
• Lips : normal
• Jaw : normal
• Ears : normal
•Neck : Lymph node normal, trachea in the middle
•Chest : Vesicular, rh -/-, wh -/-, heart sound normal,
• Abdomen : Symmetrical , soepel ,tenderness (-), mass (-),
tympanic, shifting dullness (-), peristaltic (+)
normal
•Genitalia : normal
•Extremity : Local State

6. L/S of the Left Hand
Look :
Deformity (+) Open Wound at the fingertip of the middle
finger with skin loss, bone expose, moderate
contamination and active bleeding. Swelling (-).
Feel :
Warm. Pain (+) VAS 5-6. CRT <2s
Thumb – Numbness (-) SatO2 98%
Index – Numbness (-) SatO2 97%
Middle – Numbness (-) SatO2 difficult to determine
Ring – Numbness (-) SatO2 98%
Little – Numbness (-) SatO2 99%
Move :
AROM Wrist Flexion (+) Extension (+)
Thumb – MCPJ (+) IPJ (+)
Index – MCPJ (+) PIPJ (+) DIPJ (+)
Middle – MCPJ (+) PIPJ (+) DIPJ (+)
Ring – MCPJ (+) PIPJ (+) DIPJ (+)
Little – MCPJ (+) PIPJ (+) DIPJ (+)
Distal
Proximal

7. X-Ray Pre-Operative

8. List of Problems :
• Pain
• Open Wound
• Decreased of Function
Diagnosis:
• Fingertip Injury of the Left Middle Finger, Allen Zone 3/
Tamai Zone II
Performed :
• Stump Repair with V-Y Plasty
Wolfe et al:Green’s Operative Hand Surgery. 7th Ed, Elsevier, 2017

9. Preoperative Planning
Wolfe et al:Green’s Operative Hand Surgery. 7th Ed, Elsevier, 2017

10. Post-Operative

11. Diagnosis:
• Fingertip Injury of the Left Middle Finger, Allen Zone 3 / Tamai Zone II post V-Y Plasty
Postoperative Planning :
• Adequate Analgetic
• Antibiotics
• Wound Care every 2 days
Wolfe et al:Green’s Operative Hand Surgery. 7th Ed, Elsevier, 2017

12. Maulana Hafidh/M/18YO
Open Fracture of the Right Lateral Condyle Femur Gustilo-Anderson
Grade IIIA
Performed :
Debridement + OREF
(Sunday, February 4th 2024)
dr. Diaz, dr. Mirza, dr. Milzam

13. History
Chief complaint : Open Wound at the Right Knee Joint
The patient was a motorcycle passenger brought by Police to the ER with the chief complaint of decrease of
consciousness following Motorcycle vs Truck MVA 1 hour prior to hospital admission. Headache (-) Vomiting (+). The
patient also had an open wound of 30 x 15 cm on the side of the right knee with active bleeding and bone expose.
There are also deformities on his Right Arm, Right Forearm, and Left Thigh.
History of past illness : (-)
History of last medication : (-)
History of allergy : (-)

14. Present State
Sens: E3M5V4
BP: 100/70 mmHg
HR: 120 x/min
RR: 26 x/min
T: 36,5oC
General State
•Head
• Eye : Pupil isochor equal 2mm/2mm, sclera normal,
conjunctiva normal
• Nose : normal
• Lips : normal
• Jaw : normal
• Ears : normal
•Neck : Lymph node normal, trachea in the middle
•Chest : Vesicular, rh -/-, wh -/-, heart sound normal,
• Abdomen : Symmetrical , soepel ,tenderness (-), mass (-),
tympanic, shifting dullness (-), peristaltic (+)
normal, bruising (+)
•Genitalia : normal
•Extremity : Local State

15. L/S of the Left Right Knee Joint
Look :
Deformity (+) Open Wound sized 30x15cm from the mid-
thigh to the proximal tibia with skin loss, bone expose,
high contamination and active bleeding..
Feel :
Warm. Pain (+) VAS undetermined. CRT <2s
Great Toe – SatO2 85%
2nd Toe – SatO2 99%
3rd Toe – SatO2 81%
4th Toe – SatO2 98%
5th Toe – SatO2 99%
A. Dorsalis Pedis (+) A. Tibialis Posterior (+)
Move :
AROM difficult to determine
PROM Knee Flexion-Extension unstable due to open wound

16. Distal
Proximal

17. X-Ray Pre-Operative

18. X-Ray of Other Fractures

19. List of Problems :
• Loss of Consciousness
• Multiple Trauma
• Open Wound
• Joint Instability
Diagnosis:
• Open Fracture of the Right Lateral Femoral Condyle
Grade IIIC
• Traumatic SAH with GCS 12
• Close Spiral Fracture of the Right Midshaft Humerus
• Close Oblique Fracture of the Right Proximal Shaft
Radius
• Close Spiral Fracture of the Left Midshaft Femur,
Winquist-Hansen type I
Performed :
• Debridement + OREF Emergency
• U-Slab on the Right Arm
• Volar Slab on the Right Forearm
• Skin Traction on the Left Thigh
• Planning for Multiple ORIF Elective White et al: McRae’s Orthopaedic Trauma and Emergency Fracture Management. 3rd Ed, Elsevier, 2016

20. Intraoperative Finding
Distal
Proximal
Structures Involved:
- Lateral Epicondyle of Femur
- Iliotibial Tract
- Superior Lateral Genicular Artery
- Lateral Collateral Ligament
- Lateral Patella Retinaculum
- Patella
Thompson C: Netter’s Orthopaedic Concise Anatomy. 2nd Ed, Elsevier, 2010

21. Post-Operative

22. X-Ray Post-Operative

23. Diagnosis:
• Open Fracture of the Right Lateral Femoral Condyle Grade IIIA post Debridement &
Monoplanar OREF
• Traumatic SAH with GCS 12
• Close Spiral Fracture of the Right Midshaft Humerus
• Close Oblique Fracture of the Right Proximal Shaft Radius
• Close Spiral Fracture of the Left Midshaft Femur, Winquist-Hansen type I
Postoperative Planning :
• Adequate Analgetic
• Antibiotics
• Wound Care every 2 days, monitor for pin-tract infection
• Maintain temporary immobilization
• Multiple ORIF Elective

24. Muhammad Huzaivi/M/18YO
Open Comminutive Fracture of the Right Distal Radius Grade IIIA
Open Transverse Fracture of the Right Distal Shaft Ulna Grade II
Performed :
Debridement + ORIF
(Sunday, February 4th 2024)
dr. Diaz, dr. Mirza, dr. Milzam

25. History
Chief complaint : Open Wound at the Right Forearm
The patient was a motorcycle rider brought by Police to the ER with the chief complaint of decrease of
consciousness following Motorcycle vs Truck MVA 1 hour prior to hospital admission. Headache (-) Vomiting (-). The
patient also had an open wound of 5 x 1 cm on the right wrist joint with active bleeding and bone expose. There are
also deformity on his Right Thigh.
History of past illness : (-)
History of last medication : (-)
History of allergy : (-)

26. Present State
Sens: E3M6V4
BP: 110/74 mmHg
HR: 112 x/min
RR: 20 x/min
T: 36,5oC
General State
•Head
• Eye : Pupil isochor equal 2mm/2mm, sclera normal,
conjunctiva normal
• Nose : normal
• Lips : normal
• Jaw : normal
• Ears : normal
•Neck : Lymph node normal, trachea in the middle
•Chest : Vesicular, rh -/-, wh -/-, heart sound normal,
• Abdomen : Symmetrical , soepel ,tenderness (-), mass (-),
tympanic, shifting dullness (-), peristaltic (+)
normal
• Genitalia : normal
•Extremity : Local State

27. L/S of the Left Right Forearm
Look :
Deformity (+) Open Wound sized 5 x 1cm on
the volar forearm with skin loss, bone
expose, high contamination and active
bleeding.
Feel :
Warm. Pain (+) VAS 6-7
Thumb – SatO2 99%
Index Finger – SatO2 97%
Middle Finger – SatO2 94%
Ring Finger – SatO2 98%
Little Finger – SatO2 98%
A. Radialis (+)
Move :
AROM Elbow Joint Flexion (0-105o)
AROM Wrist Joint Flexion-Extension (0o)
AROM Finger Flexion-Extension (+)
Thumbs Up (+) OK Sign (+) Peace Sign (+)
Distal
Proximal

28. X-Ray Pre-Operative

29. X-Ray of Other Fractures

30. List of Problems :
• Loss of Consciousness
• Multiple Trauma
• Open Wound
• Joint Instability
Diagnosis:
• Open Comminutive Fracture of the Right
Distal Radius Grade IIIA, Mayo IV
• Open Transverse Fracture of the Right Distal
Ulna Grade II
• Traumatic SAH with GCS 13
• Close Comminutive Fracture of the Left
Midshaft Femur, Winquist-Hansen type III
Performed :
• Debridement + ORIF Emergency
• Volar Slab on the Right Forearm
• Skin Traction on the Right Thigh
• Planning for ORIF Femur Elective Wolfe et al:Green’s Operative Hand Surgery. 7th Ed, Elsevier, 2017

31. Preoperative Planning
Court-Brown et al: Rockwood and Green’s Fractures in Adults. 8th Ed, Wolters Kluwer, 2015

32. X-Ray Post-Operative

33. Diagnosis:
• Open Comminutive Fracture of the Right Distal Radius Grade IIIA, Mayo IV post ORIF
• Open Transverse Fracture of the Right Distal Ulna Grade II
• Traumatic SAH with GCS 13
• Close Comminutive Fracture of the Left Midshaft Femur, Winquist-Hansen type III
Postoperative Planning :
• Adequate Analgetic
• Antibiotics
• Wound Care every 2 days, monitor for surgical site infection
• Maintain temporary femur immobilization
• ORIF Femur Elective