Below is a procedure that I need help with. Thanks
PREOPERATIVE DIAGNOSIS: Displaced basilar fracture fifth metacarpal.
POST OPERATIVE DIAGNOSIS: Displaced basilar fracture fifth metacarpal.
PROCEDURE: Removal of small bone fragments base of left fifth metacarpal with reattachment of the adductor tendon left wrist.
ANESTHESIA: Scalene block.
BRIEF HISTORY: The above mentioned patient is a 38 year old who sustained a fall resulting in a comminuted displaced fracture of the left fifth metacarpal and admitted now for stabilization of the same.
DETAILED OPERATIVE PROCEDURE: After induction of satisfactory scalene block anesthesia the patientâ€™s left upper extremity was prepped and draped in sterile fashion. The extremity was elevated, exsanguinated with an Esmarchâ€™s bandage. Tourniquet pressure of 250 mmHg to the upper arm tourniquet. A dorsal incision was made across the base of the left fifth metacarpal at the carpal metacarpal joint and was extended through subcutaneous tissue. Hemostasis was obtained with Bovie electrocardiographic apparatus. Extensor mechanism was reflected appropriately and we did identify the fracture fragments. There was no dislocation of the carpal, metacarpal joint. The fragments were much to small for repair and there was really no cartilage on two of those fragments therefore I very carefully removed those fragments and resewed the adductor tendon to the fascia to the periosteum of the base of the fifth metacarpal with good result. I performed capsular repair dorsally with interrupted 0-Vicryl. Subcutaneous tissues were closed with 3-0 Vicryl. Skin was closed with 4-0 Nylon.
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