Penetrating injury to hand
A 32-year-old woman presented with a door handle stuck into her left non-dominant hand. While trying to move an old door at home, it accidentally fell on her injuring the left hand. The handle had passed through the dorsal aspect of the first web space and had exited though the volar aspect of the hand. She was able to move her fingers and had no distal neurovascular deficit at presentation. The capillary refill time was less then 2 seconds and the fingers showed no discoloration. There was minimal bleeding from the wound and there were no other associated injuries. After a preliminary assessment she was immediately taken to theatre. Tetanus toxoid and intravenous antibiotics were administered. A tourniquet was used at appropriate pressure to aid the procedure. Intraoperative findings showed some 'paint' debris in the deeper tissues and the wound was washed with normal saline. The wound involved the capsule of the first metacarpophalangeal joint, which was repaired with 4-0 vicryl sutures. The integrity of tendons, nerves and blood vessels was confirmed and appropriate debridement and washout was performed. The wound was then reviewed after 48 hours and a delayed primary closure performed. The patient had regained good hand function and the wound healed unremarkably at follow-up.
