Date: Wed, 21 Aug 2002 19:13:46 +0530

Subject: Hand - 1 month s/p Human Bite

Presenting this case for opinion on management. 34 year old cottage industrialist not able to attend to work following a human bite on his left middle finger one month ago. Patient has received treatment elsewhere where incision, drainage of pus and debridement of sloughed tendons were done along with antibiotics based on culture and sensitivity. At present wounds on the dorsal and volar aspect of middle segment with absent tendons, exposed bones and unstable DIP joint. Infection still present. Stiffness PIP joint present. Clinical picture and xrays attached.

Questions:

I have advised a ray amputation. Who will vote with me? Any other plans to reduce morbidity and early functional return?

Dr.T.I. George, Consultant Orthopaedic Surgeon,
Polytrauma, Microvascular Surgery And Hand Surgery Unit,
Metropolitan Hospital, Trichur, S.India.

Date: Wed, 21 Aug 2002 09:07:46 -0500

From: Obremskey, William T

You could consider removing just distal to PIP joint where FDS attaches. Looks like that you have enough soft tissue coverage and that bone is not involved. It should be good cosmetically and not have the functional problem of objects falling out of his palm.

Bill Obremskey

Date: Wed, 21 Aug 2002 20:00:38 +0000

From: b.meinhard

Partial amputation and or ray resection if function after partial amputation is compromised.

BPM

Date: Sat, 24 Aug 2002 00:02:20 EDT

From: Aobonedoc

Amputate without a doubt. Anything else would be functionaly worse.

Sincerely and respectively,

M. Bryan Neal, MD
Arlington Orthopedics and Hand Surgery Specialists, Ltd.
1100 W. Central Road, Suite 304
Arlington Heights, Illinois 60005