Successful ORIF with K-Wire Fixation for Right Little Finger Fractures

Chief Complaints

A 55-year-old male patient with a body mass index (BMI) of 20 presented to the Plastic and Reconstructive Surgery Department at PACE Hospitals, Hitech City, Hyderabad, with a history of crush injury to the right little finger sustained two days earlier. The patient had initially received primary treatment at another hospital. There was no history of associated head, chest, or abdominal injury.

The patient was a known case of epilepsy and has been on regular treatment with antiepileptic medication. There was no history of hypertension, diabetes mellitus, thyroid disorders, tuberculosis, or asthma. The patient was a non-smoker and non-alcoholic and had no known drug allergies.

On examination, the patient was conscious, coherent, and cooperative. There was no pallor, icterus, cyanosis, clubbing, lymphadenopathy, or pedal edema. Local examination of the right little finger revealed a crush injury with soft tissue damage, tenderness, swelling, and deformity associated with fractures of the proximal and middle phalanges, along with dislocation of the proximal interphalangeal joint. Vital parameters were stable.

Upon admission to the PACE Hospitals, the patient underwent a comprehensive evaluation, including a detailed review of his medical history and a thorough physical examination by the Plastic, Orthopaedic, and Neurology teams. The patient presented with a history of crush injury to the right little finger following trauma, associated with pain, swelling, and functional impairment of the affected digit. Clinical examination and radiological assessment revealed a crush injury of the right little finger with fractures of the proximal phalanx (PPX) and middle phalanx (MPX), along with dislocation of the proximal interphalangeal joint (PIPJ).

A complete diagnostic workup was carried out, including routine laboratory investigations, viral screening, and imaging studies, which were within normal limits and did not reveal any contraindications for surgical management. The patient was also noted to have a known history of epilepsy, for which he was on regular treatment. His general systemic condition was stable, with no significant medical comorbidities contributing to the current presentation.

Based on the clinical and radiological findings, the patient was advised to undergo Crush Injury of the Right Little Finger with Fractures of PPX and MPX Treatment in Hyderabad, India, along with PIPJ dislocation under the expert care of the Plastic and Reconstructive Surgery team.

After a thorough evaluation by Dr. Kantamneni Lakshmi, Senior Consultant Plastic, Reconstructive & Aesthetic Surgeon, and in coordination with cross-consultations from Dr. Raghuram (Consultant Orthopaedic Surgeon) and Dr. S Pramod Kumar (Consultant Neurologist), a comprehensive assessment was carried out to determine the most appropriate management plan for the patient diagnosed with a crush injury of the right little finger.

Based on the clinical findings of crush injury to the right little finger with fracture of the proximal phalanx (PPX), middle phalanx (MPX), and dislocation of the proximal interphalangeal joint (PIPJ), along with associated soft tissue damage and vascular assessment of the digit, it was determined that surgical management with exploration, open reduction and internal fixation (ORIF) using K-wire stabilization, along with debridement and suturing, was the most appropriate treatment approach. This decision was made after careful evaluation of the injury severity, requirement for anatomical alignment, preservation of vascularity, prevention of infection, and restoration of hand function.

The patient and his family were counselled regarding the condition, the need for surgery, associated risks and benefits, and the importance of postoperative care, including wound care, limb elevation, medication adherence, and follow-up for optimal recovery.

Following the diagnosis, the patient was scheduled to undergo Exploration with Open Reduction and Internal Fixation (ORIF) using K-Wire Stabilization Procedure in Hyderabad at PACE Hospitals, along with debridement and suturing under right axillary block under the supervision of the expert Plastic and Reconstructive Surgery team.

The surgical procedure involved the following steps:

• Anesthesia and Preparation: The patient was taken up for surgery under right axillary block anesthesia. The operative site was prepared under strict aseptic precautions. The right upper limb was painted and draped in a sterile manner to maintain a sterile surgical field.

• Wound Exploration and Debridement: A thorough exploration of the wound over the right little finger was performed. Devitalized and contaminated tissues were carefully debrided to reduce infection risk and prepare a healthy wound bed for fixation.

• Fracture Assessment and Stabilization: Intraoperative assessment confirmed fractures of the proximal and middle phalanges with dislocation of the proximal interphalangeal joint. Open reduction was performed, and K-wire fixation was used to stabilize the MPX and PIPJ fractures by the orthopaedic team.

• Intraoperative Findings and Tissue Preservation: The proximal phalanx fracture was not addressed due to associated vascular compromise. The wound was reassessed, and vascularity of the digit was confirmed to be adequate. Intact flexor and extensor tendons were identified and preserved.

• Closure and Completion of Procedure: Hemostasis was secured, and the wound was closed with 3-0 Ethilon sutures. Aseptic dressing was applied, and the procedure was completed uneventfully with stable intraoperative condition.

During the postoperative period, the patient was managed with intravenous fluids and intravenous therapy for infection control and prevention of postoperative infection. Supportive treatment was given for pain relief and fever control. Gastric protection therapy was provided to prevent acidity related to medications and stress. Regular sterile dressings were done for the operated finger to maintain wound hygiene and promote healing. The blood flow to the injured finger was checked regularly and remained normal throughout the hospital stay. The limb was kept elevated to reduce swelling, and the patient remained stable with satisfactory recovery prior to discharge.

Upon discharge, the patient was advised oral medications to prevent and treat postoperative infection, support wound healing, reduce pain and inflammation, and protect the stomach from medication-related acidity. Additional supportive therapy was prescribed to reduce swelling in the operated finger and promote soft tissue and bone healing. Nutritional support was also advised to aid overall recovery and improve healing strength. Long-term seizure control therapy was continued as part of ongoing neurological management, with a short-term medication given for temporary seizure prevention and then stopped.

The patient was advised to elevate the right upper limb to reduce swelling and improve recovery. Proper wound care with regular cleaning and sterile dressings was instructed to promote healing and prevent infection. A high-protein diet was recommended to support tissue repair and overall recovery.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, increasing pain or swelling in the operated finger, wound discharge, bleeding, discoloration of the digit, or any signs of infection or impaired healing.

The patient was advised to return for a follow-up consultation with the Consultant Plastic, Reconstructive & Aesthetic Surgeon in Hyderabad at PACE Hospitals after 2 days.

This case highlights a crush injury of the right little finger with fractures of the proximal and middle phalanges and dislocation of the proximal interphalangeal joint requiring surgical management. The patient underwent exploration with open reduction and internal fixation using K-wire along with debridement and suturing, resulting in stable postoperative recovery with preserved blood flow to the finger. The patient was discharged in stable condition with appropriate advice and follow-up care.