FIG. 33-63

CASE 10
BONE DISTRACTION

A 22-year-old carpenter amputated the tips of his dominant index and long fingers, which were successfully replanted.

FIG. 33-64. Preoperative appearance.

FIG. 33-65. A nonunion occurred at the distal fracture site of the index finger, leading to subluxation and radial deviation. X ray.

FIG. 33-66. Improved bony position and union were achieved with percutaneous placement of a mini-Hoffman bone distraction device.

FIG. 33-67. X ray after distraction.

FIG. 33-68. Interosseous wiring and K-wire fixation.

CASE 11
NERVE RECONSTRUCTION

FIG. 33-69. A 26-year-old carpenter suffered a near-total thumb amputation, entering the carpal tunnel.

FIG. 33-70. X ray of injury.

FIG. 33-71

FIG. 33-72. Neuromas of the digital nerves to the thumb.

FIG. 33-73. Sural nerve grafts next to donor wound, left leg.

FIG. 33-74. Improved function was obtained with neurolysis of the median motor nerve and sural nerve graft reconstruction of the digital nerves to the thumb.

FIG. 33-75. Grasp.

FIG. 33-76. Opposition to little finger pulp.

CASE 12

A 38-year-old man suffered an accidental shotgun blast to the right axilla and right arm. The median and ulnar nerves were segmentally destroyed, although the radial nerve survived the humeral injury.

FIG. 33-77. Skin grafted exit wound.

FIG. 33-78. X ray of blast injury to proximal humerus.

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