gms | German Medical Science

Objectives/Interrogation: The traumatic total and subtotal amputations of the upper extremity are those with a complex management of treatment, which can result in serious morbidities. The aim of this study was to present a rare case of coronal plan injury in the distal radius, ulna, as well as carpal bones extending from the middle arm of the forearm to the palm.

Methods: A 37-year-old male mechanic was admitted to the emergency department with a subtotal amputation of the right hand. The patient had an injury in the form of an open book in the frontal plane extending from the radial and ulnar side to the palm from the right forearm 1/3 middle distal junction. This injury was classified as IIC1 according to tic-tac-toe classification (Figure 1 [Fig. 1]). When exploration was performed, it was seen that radial artery princeps pollicis branch, all finger flexors, common digital artery and nerves were cut, radius of distal radius and ulna, all carpal bones and 1. metacarpal base were separated in coronal plane. After marking the nerve and artery ends under surgical microscope, osteosynthesis was performed with K-wires and headless cannulated compression screws. Following that, only deep flexor tendons and FPL tendon were repaired. Princeps pollicis and 2 common digital artery were repaired with vein grafts and all other arteries were repaired by end-to-end anostomosis. Digital nerves were also repaired. External fixator was used to bridge the wrist. The ulnar side was left open while closure sutures were placed on the radial side and one week later groin flap was performed to close the ulnar side defect.

Results and Conclusions: After 10 months of follow-up, pulp to palm gap was 2.5 cm. Grasp and pinch were less than 50% of the opposite side. The patient recovered a subnormal sensitivity of the hand especially in the territory of the median nerve and he had no cold intolerance. Protective sensation of the 2. finger, good sense of the 3., 4.,5. fingers is recovered. Wrist extension 30°, flexion 60, forearm supination 80° and forearm pronation were 60°. Days off from work was 4 months.