SECTION F: WRIST AND HAND DISORDERS

PATIENT PRESENTATION

The patient is a 42-year-old man who owns a landscaping business. He reports he was injured approximately 2 months ago while trying to clear grass from around a lawnmower blade, resulting in the loss of skin on the top of his middle finger. On examination in the emergency room, he was found to have full thickness skin loss of about 2.5 cm in diameter from the dorsum of the proximal interphalangeal (PIP) joint of the R middle finger; damage to the central tendon was also apparent. The surgeon debrided the wound and covered the joint using a pedicle flap from the radial side of the adjacent ring finger, and a partial thickness graft to the donor site. The doctor positioned the finger near full extension; subsequent release of the flap from the adjacent finger was done and healing occurred without complication.

Though cautioned against PIP flexion, or use of the hand that involved the finger, the patient reported he had resumed his work out of necessity, though on a limited basis. He presents with a stiff, enlarged PIP joint held in flexion at 40 degrees, and DIP joint at 10 degree hyperextension. He is unable to actively extend his PIP, and passive motion is limited to 10 degree extension from the initial measurement after treatment. Active and passive flexion of the DIP is limited to 5 degrees.