Alotaibi Ahmed S, AlMarshad Felwa A, Alzahrani Abdullah M, Hossein Mohanad O, Ijaz Attiya, Ifthikar Zainab, Jarman Abdulaziz T
Plastic and Reconstructive Surgery Section, Department of Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
Occupational Therapy Section, Physical Rehabilitation Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
Plast Reconstr Surg Glob Open. 2021 Nov 22;9(11):e3923. doi: 10.1097/GOX.0000000000003923. eCollection 2021 Nov.
Central slip and volar plate injuries rarely occur in the same finger, with only two cases previously reported in published literature. In these two patients, both teenagers, two highly distinct protocols were used. Here, we report a third case involving a 51-year-old gentleman who closed a door on his left third finger.
Because the fractures were noncomminuted and only minimally displaced, he was treated nonsurgically using a multi-step process of splinting to prevent impairment of either proximal interphalangeal joint extension or flexion, combined with active range of motion exercises. This included five weeks of splinting in neutral, 24-hour daily use of a proximal interphalangeal dorsal block, followed by active range of motion exercises combined with nocturnal splinting using a PIP volar block over the next 7 weeks, with relative motion and Joint Jack splints added over the final 4 of these 7 weeks.
Twelve weeks after initial splinting, the patient's finger was pain free, with swelling largely resolved, normal extension (-10 degrees) and near-normal flexion (95 degrees) achieved, and full function restored. The patient was very satisfied with the result.
Ours is just the third case of concomitant central slip and volar plate injuries reported in the literature. Other surgeons are strongly encouraged to publish similar cases, approaches, and results, as clinical wisdom can sometimes be gleaned from even a small number of well-documented clinical cases.
中央束和掌板损伤很少发生在同一手指，此前发表的文献中仅报道过两例。在这两名患者中，都是青少年，采用了两种截然不同的治疗方案。在此，我们报告第三例病例，患者为一名51岁男性，其左手环指被门夹伤。
由于骨折无粉碎且仅有轻微移位，对其采用非手术治疗，通过多步骤夹板固定来预防近端指间关节伸展或屈曲功能受损，并结合主动活动度练习。这包括在中立位夹板固定5周，每天24小时使用近端指间关节背侧阻挡夹板，随后在接下来的7周内进行主动活动度练习并结合夜间使用近端指间关节掌侧阻挡夹板进行夹板固定，在这7周的最后4周增加相对运动和关节千斤顶夹板。
初次夹板固定12周后，患者手指无痛，肿胀基本消退，达到正常伸展（-10度）和接近正常的屈曲（95度），并恢复了全部功能。患者对结果非常满意。
我们的病例是文献中报道的第三例中央束和掌板合并损伤病例。强烈鼓励其他外科医生发表类似病例、治疗方法和结果，因为即使是少数记录完善的临床病例有时也能从中获得临床经验。
