Hand

This 55 year old lady was bitten by a dog and presented with an open fracture of the thumb. The fixation with a modern plate made from Titanium was stable enough to allow early mobilisation.

Pre-op	Post-op
$open fracture of the thumb$	$open fracture of the thumb$
	$open fracture of the thumb$

This young man broke his middle finger. I initially tried to treat this fracture without surgery using a splint, but this didn’t work. The fracture was then fixed using two mini-screws.

41 year old patient with sudden hyperextension injury.This resulted in an avulsion fracture of the insertion of the long flexor tendon of the middle finger. The tendon war repaired using 2 techniques: a traditional pull-out suture and an extra mini-screw.

$avulsion fracture$

I fixed this unstable fracture of the index finger using a low-profile plate allowing early mobilisation.

Pre-op	Post-op

This 89 year old lady had such a badly angulated fracture that surgery was required. I fixed the fracture with a low-profile titanium plate. This was stable enough to allow early mobilisation.

Pre-op	Post-op
$angulated fracture$	$angulated fracture postop$
$angulated fracture preop$

27 year old patient with an open fracture of the middle phalanx.The wound was debrided and the fracture fixed with a low-profile plate. The drill bits are so small and fragile that it’s not unusual for them to break.

Pre-op	Post-op
$open fracture of the middle phalanx preop$	$open fracture of the middle phalanx postop$
	$open fracture of the middle phalanx preop$

This patient's finger was shattered by a cricket ball. Due to the number and small size of the fragments a traditional screw fixation was not possible. A so-called Dynamic External Fixator was applied. The device is spring-loaded and distracts both the joint and the broken fragments and helps to re-align everything. This is a very rehab-intensive treatment and it takes weeks of often painful exercises to get a good functional result.

Pre-op	Intra-op


	$angulated fracture preop$

This intraarticular fracture has badly damaged parts of the PIP joint of the finger. The fracture has also resulted in dorsal subluxation of the joint. A splint was applied in the A&E department, but this didn’t correct the dorsal subluxation. A so-called dorsal extension-block splint was applied with the finger bent. This reduced the joint and allowed flexion exercises straight away. The splint needs to be straightened gradually over a period of about 3 weeks. Although the joint isn’t perfectly aligned, the functional outcome is usually very good in fully compliant patients who are happy to work hard with the hand therapists.