Staged Orthoplastic Reconstruction of a Gustilo Anderson Grade IIIB Open Proximal Phalanx Fracture of the Thumb with Segmental Bone Loss
Vol 06 Issue 1 | January 2025 | page: 18-21 | Atanu Mohanty, Anuraag Mohanty
DOI: https://doi.org/10.13107/ojot.2025.v06.i01.67
Received 19/04/2024; Reviewed 11/05/2024; Accepted 08/11/2024; Published 10/01/2025
Authors: Atanu Mohanty [1], Anuraag Mohanty [2]
[1] Department of Orthopaedics, Maharaja Jajati Kesari Medical College and Hospital, Jajpur, Odisha, India
[2] Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
Address of Correspondence
Dr. Anuraag Mohanty
Postgraduate Resident, Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
Email: anuraag98@gmail.com
Abstract
Background: The thumb contributes approximately 40 to 50 percent of global hand function. Loss or shortening of the thumb markedly impairs pinch, grasp and fine manipulation, which makes preservation and reconstruction of severe thumb injuries a priority in hand trauma.
Case presentation: A 40 year old man sustained a Gustilo Anderson Grade IIIB open fracture of the proximal phalanx of the right thumb with segmental bone loss following a machinery crush injury. He was managed with staged orthoplastic reconstruction. The first stage consisted of meticulous debridement and provisional external fixation. The second stage used a dorsal metacarpal artery based sensate flap for soft tissue coverage. The third stage involved definitive skeletal reconstruction with tricortical iliac crest bone graft and K wire fixation.
Outcome: The flap survived, the graft united, and the patient regained a stable, pain free thumb with useful opposition and pinch.
Conclusion: A planned orthoplastic strategy that combines early debridement and temporary external fixation, reliable sensate flap cover and delayed structural bone grafting can successfully salvage high grade open injuries of the thumb with bone loss and restore functional length.
Keywords: Thumb fracture, Open fracture, Orthoplastic reconstruction, Dorsal metacarpal artery flap, Iliac crest bone graft, External fixation
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| How to Cite this Article: Mohanty A, Mohanty A. Staged Orthoplastic Reconstruction of a Gustilo Anderson Grade IIIB Open Proximal Phalanx Fracture of the Thumb with Segmental Bone Loss. The Odisha Journal of Orthopaedics and Trauma. January 2025; 06;01:18-21.
https://doi.org/10.13107/ojot.2025.v06.i01.67 |
