Kindly give your opinions
Pt a lady entrepaneur running a small industrial unit
While repairing one of the machines her R hand got caught in the machine and completely crushed with loss of all fingers at MCP JOINT level and fracture both bone forearm[ open]
External fixation debridement and skin grafting
Later after 4 weeks ext fix removal and after pin tract healing ORIF and bone grafting both radius and ulna- volar approch
At present [3 months] post ORIF, wrist joint has 40 degrees of dorsiflexion and 20 degree of palmar flexion, full ROM elbow and with forearm in mid-prone position no further pronation supination possible which she finds quite disabling
Present x-ray shows union of both radius and ulna but with synostosis
What can be done- My plan is to go mid dorsal approach expose the synostosis resect it and interposition fat graft.
I would be obliged if the members could tell their expieiences as to the result of excision and fat pad grafting and any technical points that will be of help
DR C CHERIYAN KOVOOR
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