Case Discusion - Finger Fracture and Surgery (1)
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[00:00:00] So you were referred for an ulnar gutter splint. So why were you referred for an ulnar gutter splint? So it's a right ring finger, right ring finger. Um, there is an ORAF, so an ORAF here to the right middle, um, to the ring finger, middle, digital nerve repair, digital nerve. Um, so the flexor pollicis, I'm sorry, the flexor digitorum profundus, so repair here.
So it's a repair to the profundus, so it might have been lacerated right here in that middle because it was a middle phalanx fracture. A digital nerve repair, an FTP repair, a volar plate repair, as well as a DIP. So probably the volar plate, I would assume, [00:01:00] is happening here at the DIP, most likely. Versus the P.
I. P. Just because if there was a bowler plate repair at the P. I. P. I would imagine the superficialis having been injured too. So it sounds like there was a crush injury right here at the ring finger. So, um, This person fractures, um, fracture was a middle phalanx fracture, which is intra articular to the DIP, resulting in subluxation, which is why the DIP was pinned.
Great. So I was thinking of just making an ulnar gutter as suggested and do a forearm base due to a tendon repair. So this is really tricky because you're pinning, um, cause you're pinning so much down. Right, because you're pinning so [00:02:00] much down that, and there's a, there's a pinning at the DIP. So that pretty much tells me that you don't need to make a long forearm base one.
If anything, You know, if there wasn't a profundus injury, you would really just need to splint the ring finger like you're literally making a canoe, um, for the finger. Now, usually with a digital nerve repair, you would want that P. I. P. At like a 20 degree flexion position. If there was no nerve tension, you can make it straight, but usually in the finger, and especially with this severity, I put that PIP in a little bit of a flexion position and that splint will cover the DIP and it would go to, um, it would go to zero.
You don't have to worry [00:03:00] about the MP and the wrist, and you don't have to worry about the profundus. Only because the D. I. P. is pinned. So that profundus repair. isn't going to go anywhere. Normally we stop the, all the flexor policies. I mean, why do I keep saying Paul is we stop all the flexor digitorum profundus from moving through the wrist and stuff like that.
But that's because the DIP is able to make a fist and move. In this case, we have a fracture with the, um, tendon problem because you have to stabilize for the fracture. The tendon can't go anywhere. Let me know if that makes sense. So you can either make an ulnar gutter brace as prescribed. You would stop at the hand base and you would position the MP And, uh, 60 degrees and then all these here at zero or the, the [00:04:00] PIP at a slight flexion and you include the ring finger and the small finger, or you could just make a finger splint, right?
Um, so I would just go with a, you know, to be on the safe side. Um, if they're, if they're asking for an ulnar gutter, um, I would go ahead and just do the ulnar gutter. Um, You know, again, I'd go with the only daughter just to be on the safe side and also using the ring finger to help protect. Um, sorry, using the small finger to help the ring finger protect itself and then make it only hand based don't cover the risks because you don't need to.
All right, let me know. Let me know if that helps, especially because of the severity and stuff like that. Let me let me know if that helps. But you're allowed to move the small finger, uh, the ring finger and all that good stuff. And you're allowed to go into MP flexion extension because that PIP and [00:05:00] that DIP probably isn't going anywhere for like a hot minute.
Um, all right.
