Orthopedics Case Study

EMERGENCY ROOM REPORT

SUBJECTIVE

This patient sustained a laceration to his left index finger with an X-ACTO knife approximately 10 minutes prior to arrival in the emergency room.  The patient’s last tetanus immunization was greater than 5 years ago.  He noted no loss of sensation in the distal digit and noted that he is right-hand dominant.

OBJECTIVE

Findings reveal a 4-cm laceration in a V shape with the apex of the cut towards the distal digit on the radial aspect of the digit.  There was no loss of sensation in the distal digit.  There was heavy bleeding noted, and a Penrose drain tourniquet was applied.  Hemostasis was thence obtained, and the wound was irrigated with Betadine and saline followed by copious amounts of saline.  There was no evidence of tendinous involvement, and full flexion was observed as well as extension.  The wound was explored, and the digital nerve was identified and seemed to be intact, although it was very nicely exposed.  Several small digital rays were observed to have been severed.  The wound was closed.  The wound was dressed with Polysporin.  An aluminum splint was applied.

ASSESSMENT

A 4-cm V-shaped laceration, radial aspect of left index finger, sutured.

FOOTNOTE

Line 9.  The brand name X-ACTO is spelled in all capital letters on the packaging and product; however, it may be written with upper and lowercase letters, X-Acto.

Line 25.  Although the word ray can refer to a finger, it also is defined as “any of a system of parts radially arranged.”  Thus, the physician could be referring to nerves, tendons, vessels, or other radial structures in the hand when he states that several small digital rays were observed to have been severed.