Tendon Injuries: A Case Study
Discussion:
Extensor tendon lacerations most commonly occur in men (83%), in the dominant hand (60%), in the thumb and secondly the index finger (Patillo and Rayan 2012). Tendon injuries were found to be caused by a variety of mechanisms in a study done in 2014 that include a knife, saw, crush injury, degloving injury, and bite injury (De Jong 2014).
The patient can present in different manners depending on what zone is affected. Zone I can cause a mallet finger deformity where the tip of the finger distal to the DIP cannot extend. Zone II injuries can affect the central slip. These injuries should be tested with an elson test to check if the central slip is intact. This test is done by flexing the PIP over the edge of a table and checking …show more content…
Options were discussed among physicians since the patient had remained at work for an unknown amount of hours and then went to an urgent care facility where the laceration was sutured closed. There is little research on the infection rate of re-opening wounds in relation to exploration of tendon injuries. However, it is known that the “golden period” for treatment of an acute wound is 6 hours based on studies of bacterial colonization. An acute wound should be cleaned and repaired before this time (Waseem 2012). It is unclear if the patient made it to the urgent care within a 6 hour period of time, but the bacterial contamination was most likely less at this point in time than at the time of his presentation in the emergency department. The decision to either re-open the wound to explore the tendon or keep the wound closed was made through clinical reasoning. Residents and attendings decided that the outcome of his strength and testing of his finger was fairly functional and with re-opening the wound the possibility of introducing or re-introducing an infection could be more harmful to the patient. It was also discussed that even if they re-opened the wound, the tendon may not even need to be repaired. With little research in this area, clinical judgement along with the explanation of the circumstances with the patient were key in deciding the best plan of treatment in this
Extensor tendon lacerations most commonly occur in men (83%), in the dominant hand (60%), in the thumb and secondly the index finger (Patillo and Rayan 2012). Tendon injuries were found to be caused by a variety of mechanisms in a study done in 2014 that include a knife, saw, crush injury, degloving injury, and bite injury (De Jong 2014).
The patient can present in different manners depending on what zone is affected. Zone I can cause a mallet finger deformity where the tip of the finger distal to the DIP cannot extend. Zone II injuries can affect the central slip. These injuries should be tested with an elson test to check if the central slip is intact. This test is done by flexing the PIP over the edge of a table and checking …show more content…
Options were discussed among physicians since the patient had remained at work for an unknown amount of hours and then went to an urgent care facility where the laceration was sutured closed. There is little research on the infection rate of re-opening wounds in relation to exploration of tendon injuries. However, it is known that the “golden period” for treatment of an acute wound is 6 hours based on studies of bacterial colonization. An acute wound should be cleaned and repaired before this time (Waseem 2012). It is unclear if the patient made it to the urgent care within a 6 hour period of time, but the bacterial contamination was most likely less at this point in time than at the time of his presentation in the emergency department. The decision to either re-open the wound to explore the tendon or keep the wound closed was made through clinical reasoning. Residents and attendings decided that the outcome of his strength and testing of his finger was fairly functional and with re-opening the wound the possibility of introducing or re-introducing an infection could be more harmful to the patient. It was also discussed that even if they re-opened the wound, the tendon may not even need to be repaired. With little research in this area, clinical judgement along with the explanation of the circumstances with the patient were key in deciding the best plan of treatment in this