Case history: Male patient 24 years of age. Professional lorry driver. His company is a member of our Asepeyo medical insurance company. On 9th March 2006 he had a road accident while at work. He has no other relevant medical or pathological background. He was sent to our Centre’s Emergency Department where the following was established:
1. Uneven injury to left forearm, carpus and hand with exposure of thenar musculature and involvement of thumb neurovascular bundles.
2. Fracture of the mid-proximal third of the radius, dislocation of the trapezium metacarpal and metacarpus- phalangeal joints (partial amputation of the left thumb).
3. Traction injuries to radial muscles and tendons, the short and long extensors and abductor of the thumb, the flexor carpi radialis and palmaris longus, extensor, abductor, flexor digitorum superficialis tendon and flexor digitorum profundus tendon of the 5th finger, flexor carpi ulnaris and extensor carpi ulnaris.
4. Loss of substance from the radial artery and elongation of the ulnar artery. Tearing of the ulnar nerve and the sensory branch of the radial nerve. The median nerve conserved its integrity.
5. Multiple contusions and wounds.
Reduction and osteosynthesis were carried out on the radial fracture by inserting a plate and screws. Reimplantation of the thumb and osteosynthesis by means of Kirschner-type wires.
Immediately postoperatively, venous and arterial thrombosis occurred, with subsequent necrosis of the thumb. As a result, the decision was taken to amputate the thumb on 17th March 2006 (eight days after the injury).
The negative development resulted in the appearance of purulent secretion secondary to the muscle necrosis.
Extensive surgical cleaning was undertaken on 21st March 2006 and local cures were started with sugar, tulgrasum and bringing the edges of the wound together with a vessel loop closure system.
On 20th April 2006 skin covering was carried out using a laminar free skin graft.
The skin result after 6 months of development was satisfactory. However, the radius fracture evolved towards pseudarthrosis in the successive radiological checkups.
On 23rd October 2006 the index finger was transposed to the thumb to give a useful grip. The skin flaps started to show signs of suffering and vascular compromise.
On 2nd March 2007, tenolysis and tenorrhaphy were performed on the flexors and extensors of the 4th and 5th fingers and the radius plate was removed.
The focus of the pseudarthrosis was cleaned and a premoulded autologous bone graft from the contralateral iliac crest provided.
On 26th September 2007 he was given permission to return to work with after-effects.
