Proc: Excisional debridement to bone of distal phalanx of left middle from radial and ulnar aspects
2. Removal of deep buried foreign bod
3. Excisional debridement of open fracture of middle phalans, left ring finger.
4. closed treatment without manipulation of open fracture of middle phalanx left ring.
5. Removal of 16-penny nail, left ring finer, right middle phalanx
The patient was taken to the operating room after having had 2 g of Ancef IV in the ER, and he was administered general endotracheal anesthesa with excellent effect. The left upper extremity was prepped and draped in a sterile fashion. A small bolt cutter was used to sever the nail between the middle and ring fingers, and then it was easily removed from the middle finger because it was very soft tissue only and it just grazed the volar edge of the distal phalanx. Because of the potential for the connecting material such as paper or plastic to be carried into this wound, the wound was opened a total of 3/4 inches on each side of the puncture, and then carefully with blunt and sharp dissection was dissected, and excisional debridement was down to the bone from the radial and ulnar side, and no foreign material was noted leaving thus with the satisfactory assumption that as it entered the skin the paper coating was stripped off externally. Then this was copiously irrigated, and after an excisional debridement was done of soft tissue and skin, the incised area was closed, and the puncture area was packed with a wick of 1/4 inch NuGauze. Then on the ring finger, the nail was removed with some more difficulty, pulling it out using the distal end and only having a few millimeters on the proximal end to pull through the tissue, and this was carefully excisionally debrided from the radial and ulnar side as well down to the fracture area.
On the C-arm, it was noted that it had penetrated the volar distal phalanx at an angle and had created a small fracture line without much displacement, and after careful irrigation and debridement and packing this with a wick as well, then a Marcaine block was given and a sterile dressing applied, and the patient was awakened and taken to recovery room in stable contion. Postop x-ras will be taken in recovery room to show futher delineation of the fracture area with more detail and will help dicate postop treatment.