[ORT-L] Fwd: [Ortho] gunshot wound of the thumb


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[ORT-L] Fwd: [Ortho] gunshot wound of the thumb

alex at weborto
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Feb 3, 2009, 10:21 PM

Post #1 of 2 (143713 views)
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[ORT-L] Fwd: [Ortho] gunshot wound of the thumb	Can't Post

Dear colleagues,

This is a forwarded message
From: Danil Bliznets <orthoforum@weborto.net>
To: ortho@weborto.net
Date: Wednesday, February 4, 2009, 11:00:35 AM

===8<==============Original message text===============
Colleagues! Female 18 years old sustained a shot through her thumb
with a pistol (9 mm) one month ago. Debridement and external fixation were
performed on admission. Wound healded primarily. Flexor and extensor
tendons are intact. What tactic
s should be optimal for now?
Arthrodesis or arthroplasty? With bone grafting? We have available
Ariadna and Avanta SR MCP by Small Bone Innovations, but we doubt about
its feasibility taking into account the present bone defect.

Best regards, Danil Bliznets
Ural Scientific Research Institute of Traumatology and Orthopaedics,
Ekaterinburg, Russia.
===8<===========End of original message text===========

--
Best regards,
Alexander N. Chelnokov
Ural Scientific Research Institute
of Traumatology and Orthopaedics
7, Bankovsky str. Ekaterinburg 620014 Russia

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jjbrooksmd at gmail
New User

Feb 4, 2009, 6:53 AM

Post #2 of 2 (143712 views)
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Re: [ORT-L] Fwd: [Ortho] gunshot wound of the thumb [In reply to]	Can't Post

Hi Danil,

Thanks for sharing this case. I like that fixator you've got on there!

I am very surprised there is no radial digital nerve injury and the
FPL is ok. Lucky young lady.

My vote would be for thumb MP fusion with distal radius autograft and
fixation of your choice (tension band, accutrak screw, etc). Might
require 3-4mm of shortening but be careful about shortening too much.
That radial side of P1 is gone, as is the dorso-radial metacarpal
head. There will be a big hole to fill but I imagine it's do-able.
Just resist the temptation to over-shorten.

Not enough good bone stock to solidly hold any implant in my opinion,
and if her CMC and IP joints are mobile and OK she'll do fine with a
fused MP joint. How stiff is that thumb IP joint?

Sincerely,

Jeff

Jeffrey J. Brooks, MD
Stamford, CT

On Feb 4, 2009, at 1:21 AM, Alexander Chelnokov wrote:

> Dear colleagues,
>
> This is a forwarded message
> From: Danil Bliznets <orthoforum@weborto.net>
> To: ortho@weborto.net
> Date: Wednesday, February 4, 2009, 11:00:35 AM
>
> ===8<==============Original message text===============
> Colleagues! Female 18 years old sustained a shot through her thumb
> with a pistol (9 mm) one month ago. Debridement and external
> fixation were
> performed on admission. Wound healded primarily. Flexor and extensor
> tendons are intact. What tactic
> s should be optimal for now?
> Arthrodesis or arthroplasty? With bone grafting? We have available
> Ariadna and Avanta SR MCP by Small Bone Innovations, but we doubt
> about
> its feasibility taking into account the present bone defect.
>
> Best regards, Danil Bliznets
> Ural Scientific Research Institute of Traumatology and Orthopaedics,
> Ekaterinburg, Russia.
> ===8<===========End of original message text===========
>
>
>
> --
> Best regards,
> Alexander N. Chelnokov
> Ural Scientific Research Institute
> of Traumatology and Orthopaedics
> 7, Bankovsky str. Ekaterinburg 620014 Russia<1.JPG>

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