Open thumb flexor pollicis longus tendon avulsion with fracture

gsteeves

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Local Chapter Officer
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Good Afternoon,

Need some help with the following procedure:

The patient was taken to the operating room, placed in the supine position on the operating room table. General anesthesia was administered without complication. The right upper extremity was prepped and draped in the usual sterile manner. The tourniquet was inflated to 250 mmHg pressure. All the sutures were removed and the skin flap was folded back. All the blood was evacuated out of the wound. There was a lot of blood present. It was vigorously irrigated. I identified the injury. The flexor pollicis longus tendon had avulsed off the bone. There was a small piece of bone with it. After reducing the bone to its fragment I was able to pull the flexor pollicis longus tendon up to its insertion. I place a K-wire across the bone to hold it. It held it nicely. I felt as though the base way to fix this was with two screws. I made a small slit in the tendon down to the level of the bone, predrilled the distal phalanx in the intact bone with a 1.1 drill and inserted a 1.5 mm screw from the Synthes Modular hand set. I inserted another screw where the K-wire had been placed, another 1.5 mm screw. This fixed the tendon fairly securely. The wound was washed out again. The tourniquet was let down. Blood flow returned to the tip of the thumb and the flap. The flap was inspected for digital nerves to repair. Unfortunately where the saw had injured the soft tissue there really was not any left to repair. The skin was closed with 5-0 nylon sutures followed by Adaptic, 4x4s, Sof-Rol and a volar thumb spica splint in flexion.

Thanks for your help!
Gail Steeves,CPC
 
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