Hand Wound Monday: Floppy Tips

From the Case of the Week:

"I just can't hold anything with this finger - it's too mushy...".

That's the reason he is here, explains your patient. He had a saw injury of his dominant hand index dorsal fingertip about two years ago, and was told that he was lucky that he didn't lose his finger. It took months to heal. The tip is is neither very painful nor tender. Nonetheless, he has been troubled by the fact that his fingertip is "wobbly" or soft", which interferes with two point pinch and fine manipulation. He is bothered to a lesser degree by the fact that it is shorter than the opposite hand index finger. The finger looks like this:

Follow Up: This patient's problem was treated with bone grafting using a novel approach. Immediately before grafting, the phalanx was restored to pre injury length by a period of distraction lengthening.

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