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8/18/2019 Management Thumb Tip Injuries_Germann_JHS 2015
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EPTT@O] EAOE@V]U
Njojh`n`ot al ]bund ]ip Iokuri`s
Hóot`r H`rnjoo, NM, VbM, Niebj`c Uju`rdi`r, NM, VbM,
Gcjus M. Tumacl, NM, Njou`c Brjdawsgi, NM
]b` njojh`n`ot al tbund tip iokuri`s bjs uom`rhao` hr`jt ebjoh`s io r`e`ot y`jrs. ]b`
trjmitiaojc jrnjn`otjriun al jps bjs d``o `xpjom`m jom r`pcje`m dy j wim` vjri`ty al jps
witb nar̀ v`rsjticity jom c`ss maoar sim` nardimity. Vjrjcc̀ c ta tb` m`v`capn`ot al o`wjps, tb`
eaos`rvjtiv` tr`jtn`ot al tbund tip iokuri`s witb s`ni-aeecusiv` mr`ssioh bjs hjio`m hrauom io
tb` tr`jtn`ot al tb`s` iokuri`s. Jctbauhb t`miaus jom tin`-eaosunioh, jom r`quirioh iot`osiv`
eannuoiejtiao witb tb` pjti`ot ta `xpcjio tb` caag jom aeejsiaojccy l`tim sn`cc al tb` wauom,
tbis t`eboiqu` yi`cms `xe`cc`ot r`sucts witb r`sp`et ta r`starioh eaotaur jom s`osidicity io pucp
iokuri`s. ]b` jrtiec` hiv`s jo upmjt` ao tb` eurr`ot aptiaos lar tr`jtioh tbund tip iokuri`s
ioecumioh tb` nast eannaocy jppci`m
jps. (K Bjom Uurh Jn. 46:07=6(5);
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LIOH@T]IV IOKPTI@U JT@ ]B@ nast lr`qu`otcy
`oeauot`r`m iokuri`s io tb` upp`r cind, d`ejus`
it is tb` njio jutacahaus taac us`m dy prinjt`s
jom bunjos. ]b` oh`rtips jr` tb` nast inpartjot
arhjos al tjetic` s`osidicity. ]wa-paiot miseriniojtiao
usujccy is d c̀aw 0 nn awioh ta tb` m`osity al
\jt`r ̀ Vjeioi dami`s jom tb` drjoeb`s al tb` pjcnjr
mihitjc o`rv`s r`spaomioh ta tjetic̀ stinuci jompravimioh sgio s`osidicity. ]b` jojtanie struetur`s al
tb` pucp witb its sudeutjo`aus jrebit`etur` jr` cjim
aut ta witbstjom sudstjotijc pr`ssur` jom sb`jr lare`.
Tieb jrt̀ rijc dcaam is suppcì m ta tb` oh`rtip dy
t`rniojc drjoeb`s al tb` njio pjcnjr mihitjc jrt`ri`s.
\`oaus dcaam mrjiojh` ao tb` pjcnjr sim` is pravim`m
dy tb` sup`r eijc pjcnjr v`ios jom adciqu` eannu-
oiejot v`ios.
Ecjssiejtiao al tbund tip m`l`ets is oat ec`jrcy
m`o`m io tb` cit`rjtur`. Psujccy m`l`ets jr` m`o`m
jrditrjricy js snjcc ar cjrh`.
:
Atb`r m`
oitiaos us` tb`struetur`s iovacv`m sueb js tb` pucp, ojic, j om dao`,
wbieb jcsa m`o` tb` caejtiao al tb` iokury.4,5
Psioh
datb erit`rij m`oitiaos nast cig`cy hiv`s tb` d`st
djsis lar s`c̀ etioh tb` jppraprijt` r`eaostruetiv`
n`tbam.
]b` s`c`et`m t`eboiqu` al m`l`et r`eaostruetiao
m`p`oms ao njoy ljetars sueb js tb` ojtur` al tb`
iokury7 tb` siz`, caejtiao, jom eaomitiao al tb` m`l`et7
tb` pjti`ot ’s jh`, h`om`r, jom h`o`rjc b`jctb eaomi-
tiao7 jom tb` pjti`ot ’s pral`ssiaojc prac`.
]b` hajcs io oh`rtip jnputjtiao r`eaostruetiao
jr` ta eav`r tb` m`l`et witb j sjtisljetary easn`tiejpp`jrjoe`, `stjdcisb njxinun tjetic` hoasis, pr`-
s`rv` tb` c`ohtb al tb` tbund, adtjio j w`cc-pjmm`m
pucp tissu ,̀ pr s̀`rv` jo iotjet ojic d`m, jom nioi-
niz` tin` all warg.
Oun r̀aus n`tbams lar r`eaostruetioh oh`rtips
jr` m`serid`m io tb` cit`rjtur`, wbieb earr`cjt` ta tb`
prioeipc` al tb` r`eaostruetiv` cjmm`r. ]b`s` rjoh`
lran b`jcioh dy s`eaomjry iot`otiao jom sgio hrjltioh
ta sin pc` pjcnjr \`Y pcjsty jom dicjt`rjc \`Y
pcjsty,=`<
vjriaus iscjom jps, jom `v`o lr`` ta` pucp
trjosl`r lar cjrh` m`l`ets. Ugio hrjltioh al tb` m`l`et isjo `jsy n`tbam dut usujccy r`sucts io paar s`osary
luoetiao7 tb`r`lar`, it sbaucm d` eaosim`r`m aocy il
atb`r aptiaos jr` oat l`jsidc`. B`jcioh dy s`eaomjry
iot`otiao (`h, uom`r j s`ni-aeecusiv` mr`ssioh) bjs
d``o `stjdcisb`m js j haam n`tbam lar snjcc ta n`-
miun m`l`ets witbaut `xpasur` al dao` ar t`omaos. Il
suee`ssluc, it r`sucts io jo `xè cc̀ ot eaotaur jom
eaosist`oey al tb` pucp witb sjtisljetary r`turo al
s`osary luoetiao.
Lcjps us`m lar tbund tip r ̀ eaostruetiao jr`
ecjssi`m js banamihitjc jps,=`:0 b`t`ramihitjc
(erass-oh`r),:
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ioecum`s tb` s`osary drjoeb al tb` rjmijc o`rv`.
Jctbauhb tb` git̀ jp wjs prinjricy iot̀ om`m lar
marsjc m`l`ets, it is lr`qu`otcy us`m t a r ̀ star` tbund
s`osidicity io ejs` al cass al tb` pucp.=4
]b` git` jp
pravim`s inn`mijt̀ s`osidicity jom is tb`r`lar`
`sp`eijccy iomiejt`m io acm`r pjti`ots, io wban o`rv`
eajptjtiaos ma oat yi c̀m sjtisljetary r`sucts. U`e-
aomjry m`l`et r`eaostruetiao is usujccy p`rlarn`mwitb lucc-tbiego`ss sgio hrjlts (Lihs. 4, 5).
Jctbauhb tb` git` jp bjs `vacv`m js tb` warg-
bars` lar tbund r`eaostruetiao, jct`rojtiv`s njy d`
o``m`m wb`o tb` iom`x oh`r is oat jvjicjdc` js j
maoar sit`. Njoy jojtaniejc stumi`s bjv` m`serid`m
tb` eaostjot jom pr`mietjdc` jojtany al tb` mar-
saucoj r jom marsarjmijc drjoeb jrt r̀y al tb`
tbund.0,59,=5`=0
]bis c`m ta tb` m`v`capn`ot al jps
lran tb` marsun al tb` tbund n`tjejrpjc jr`j.
T`v`rs`m aw rjmijc banamihitjc p`miec`m jp]b` rjmijc r`v`rs`m aw p`miec`m jp wjs rst m`-
serid`m dy Naseb`ccj jom Ear mavj =<
io 466
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wauom iol`etiao rjt̀ . It is oarnjc lartb` wauom ta sn`cc
putrim jom lar tb` sgio ta d` nje r̀jt`m io tb` jr`j al tb`
trjospjr`ot jmb s̀iv` mr`ssioh. ]b` s`ni-aeecusiv`
mr`ssioh jets js jo jrtieijc sgio tbjt pr`s̀ rv`s tb`
pB, t`np`rjtur`, pacynarpb jeeunucj tiao, innuoa-
hcaducio eaoè otrjtiao, jom naistur̀ .05
]b` s`ni-
aeecusiv` mr`ssioh jccaws millusiao al axyh`o jom
pr`v`ots lurtb`r eaotjniojtiao dy arhjoisns lran
autsim`.04
Xitb tbis sinpc` jom io`xp`osiv` n`tbam,
m`l`et ecasur` is jebi`v`m io j r`jsaojdcy sbart tin`.
M`p`omioh ao tb` siz` al tb` m`l`et jom tb` iomivimujc
eaostitutiao, tb` tin` lar eanpc`t` wauom ecasur` is
oarnjccy 4 ta 2 w``gs. Jlt`r tbjt, tb` pucp r`hjios jo
jcnast oarnjc eaotaur jom io njoy ejs`s tb` tbund ar
oh`rpriot sbaws eanpc`t` r`stitutiao (Lih. 8). U`osi-
dicity r`turos ta oarnjc witbio j l`w w``gs.
J
E
D
M
LIHPT@ 4; J Bymrauarie jeim duro al tb` tip al tb` tbund witb cass al tb` ojic d`m jom `xpasur` al tb` praxinjc pbjcjox. D Utjrt al
miss`etiao al tb` rst MNEJ jp. It is inpartjot ta pr`s`rv` tb` cjrh` sudeutjo`aus v`ios ta pravim` tb` d`st passidc` v`oaus aut aw.
E ]b`
jp is rjis`m jom tb` vjseucjr p`miec` is s`eur`m dy ioecumioh tb` ljseij al tb` iot`rass`us nusec`. M
]b`
jp jlt`r b`jcioh jomioearparjtiao iota tb` m`l`et.
]BPND ]IV IOKPTI@U
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MIUEPUUIAO
Jmvjoe`s io jojtaniejc goawc`mh`, prahr`ss io sur-
hiejc iostrun`ots jom jvjicjdc` m`vie`s, jom iooavj-
tiv` surhiejc t`eboiqu s̀ bjv` `objoè m salt tissu`
r`eaostruetiao al tb` bjom. Eaostjot inprav`n`ot io
m`siho jom bjrv`stioh t`eboiqu`s bjs c`m ta jp r`-
o`n`ots r`suctioh io eaosim`rjdcy nar` jpp`jcioh
j`stb`tie r`sucts io salt tissu` r`eaostruetiao.
Jctbauhb caejc jp eav`rjh` bjs tb` d`o`t al
pr`s`rvioh tb` tbund c`ohtb jom is pr`l`rr`m lar
wauom ecasur` jlt`r dao` sbart`oioh, it is uol`jsidc`
io pjti`ots witb `xtr`n`cy cjrh` m`l`ets ar io ejs`s
wb`r` tb` jmkje`ot tissu` is io paar eaomitiao. Caejc
banamihitjc jps jr` `jsy ta jppcy, tb`y ma oat o``m
nierasurhiejc iostrun`ots, tb` surhiejc tin` is r`cj-
tiv`cy sbart, tb`y ma oat o``m j pracaoh`m innadi-
cizjtiao p`riam, jom tb`y jccaw pjti`ots ta r`turo ta
warg `jrcy.
Cjrh r̀ m`l̀ ets njy r`quir` r`hiaojc jps sueb
js tb` rst MNEJ jp52,59
ar `v`o nier asurhiejc
sacutiaos sueb js bypatb`oj r p`r larjtar jp00
ar lr``
pucp jp lran tb` hr`jt ta`.56,5:
J D
E M
LIHPT@ 5; J T`eurr`ot jrt`riav`oaus njclarnjtiao iovacvioh tb` `otir` pjcnjr tip al tb` tbund. D T`s`etiao m`l`et jlt`r eanpc`t`
r`navjc al tb` vjseucjr tunar. E ]ip r`eaostruetiao witb j o`uravjseucjr-s`osidc` rst MNEJ jp ta r`star` s`osidicity jom tb` salt
tissu` m`l`et sinuctjo`auscy. M ]b` jp jt 4 w``gs jlt`r surh`ry.
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Baw`v r̀, d`ejus̀ al tb` cinit`m jvjicjdicity al
caejc salt tissu`, r`eaostruetiao al tbund tip iokuri`sjom jee`ptjdc` luoetiaojc jom easn t̀ie autean`s
r`njio ebjcc`oh`s lar tb` bjom surh`ao.
]b` iotriosie jps jr` w`cc-`stjdcisb`m lar tbund
tip r`eaostruetiao io eanpc`x m`l`ets. Baw`v`r, io
r`e`ot y`jrs tb` n`tbams al tbund tip r`eaostruetiao
bjv` ebjoh`m mrjnjtiejccy. ]b` tr`jtn`ot r`hin`o
usioh j s`ni-aeecusiv` mr`ssioh bjs d`ean`
ioer`jsiohcy papucjr io c`ss eanpc`x situjtiaos.
]br̀ ` erit`rij m`t̀ rnio` tb` ebaie` al tb` im j̀c
r`eaostruetiao n`tbam al tb` tbund tip; tb` siz` al
tb` m`l`et, tb` struetur`s iovacv`m (sgio, salt tissu`,jom dao`), jom tb` caejtiao al tb` iokury (pjcnjr,
rjmijc, ucojr, ar marsjc).
Eaosim`rjtiao lar r`eaostruetiv` prioeipc s̀ is
lr`qu`otcy djs`m ao m`l`et siz`. Djs`m ao tb` ljet tbjt
tb` siz` al j njc` tbund tip is 5 ta = en caoh jom :.0
ta 4.0 en wim`, m`l`ets al = en 4
eanpris` jppraxi-
njt`cy 06% al tb` `otir` surlje` al tb` tbund tip. X`
r`eann`om spcittioh tb` m`l`ets iota 4 hraups; ao`
tbjt eanpris`s c`ss tbjo 06% (= en 4
ar c`ss) jom
ao` nar` tbjo 06% al tb` siz` al tb` tip al tb` tbund
(= en 4
ar nar̀ ). ]b` ebjrjet`risties al tb` tissu`
iovacv`m jom tb` caejtiao jr` `qujccy inpartjot
erit`rij io tb` m`eisiao-njgioh prae`ss.]b` stumi s̀ al N`oo`o jom Xì s`
0= jom Zu c̀c
`t jc0<
sbaw`m tbjt tb` njio d`o`ts al tb` s`ni-
aeecusiv` mr`ssioh n`tbam jr` r`eaostruetiao al
tb` tip witb haam sgio qujcity, oarnjc s`osidicity,
r`tjio`m natiao, cjeg al pjio, haam j`stb`ties, jom oa
maoar sit` nardimity. Baw`v`r, oa stumi`s n`otiao`m
m`l`et siz`s tr`jt`m witb tbis n ̀ tbam. ]b`s` r`sucts
jom r`parts lran atb`r hraups0=
njg` tbis oaoiovj-
siv` n`tbam tb` prae`mur` al ebaie` io nast m`l`ets,
wb`o`v`r jppciejdc`.
Il tb` m`l`et is nar` tbjo 06% al tb` siz` al tb` tipal tb` tbund (= en
4ar nar`) ar bjs j lrjetur` al tb`
dao` ar kaiot iovacv`n`ot, r`eaostruetiao witb jo
iotriosie, r`hiaojc, ar `v`o lr`` jp is iomiejt`m. ]b`
caejtiao al tb` iokury b`cps io s`c`etioh tb` d`st jp.
Mivimioh tb` tbund tip iota = jr`js b`cps tb` m`eisiao.
Lar iokuri`s al tb` pjcnjr tip tb` Nad`rh jp r`njios
tb` wargbars .̀ It pravim`s inn`mijt` s`osary luoetiao
jom j oarnjc oh`rpriot pjtt`ro. Jmvjoe`n`ot al tb`
jp is cinit`m ta :.6 ta :.0 en. Io cjrh`r m`l`ets \`Y
`xt`osiaos, Durraw trijohc`s jt tb` djs` al tb` jp, ar
lucc-tbiego`ss sgio hrjlts jlt`r mivimioh tb` praxinjc
J D
E M
LIHPT@ =; J Jvucsiao iokury al tb` marsjc tip al tb` tbund witb cass al tb` ojic d`m jom `xpas`m dao`. D M`siho al tb` r`v`rs`m rjmijc
aw banamihitjc jp (Naseb`ccj jp). E ]b` jp is rjis`m djs`m ao tb` r`eurr`ot marsjc rjmijc jrt`ry. M ]b` jp is sutur`m iota tb`
m`l`et.
]BPND ]IV IOKPTI@U
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sgio drimh` njy d` iomiejt`m. Mrjwdjegs al tbis jp
njy d` `xiao eaotrjetur` al tb` iot r̀pbjcjoh`jc
kaiot ar j pjrrat ojic m`larnity io rjr` ejs`s.
Lar cjrh`r m l̀ èts io tbis r`hiao, tb` s`osjt̀ rst
MNEJ jp bjs `vacv`m j s j us`luc aptiao. Djs`m ao
tb` warg al ]ríogc` `t jc,=4
tb` jp pravim`s inn`mijt`
s`osjtiao dy ioecumioh tb` s`osary drjoeb al tb` rjmijc
o`rv .̀ ]b` ioeim`oè al mujc caejtiao pb`oan`oao is
caw, wbieb iomiejt`s tbjt s`osary r` m̀uejtiao al tb`eart`x is `xe`cc`ot. ]bis is j njkar jmvjotjh` io acm`r
pjti`ots, io wban o`rv` eajptjtiao ar ioo`rvjt`m lr``
jps yi`cm wars` r`sucts witb j nueb caoh`r b`jcioh
iot`rvjc.
]b` rjmijc r`v`rs`m aw ban amihitjc iscjom jp
m`serid`m dy Naseb`ccj `t jc=
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Lar r`eaostruetiao al tb` marsjc tip jom ojic d`m, tb`
ucojr r`v`rs`m aw banamihitjc jp m`serid`m dy
Druo`cci,06
tb` rjmijc r`v`rs`m aw banamihitjc iscjom
jp, jom tb` rst MNEJ jp ejo d` us`m, m`p`omioh
ao tb` m`l`et siz`. T`starjtiao al s`osary luoetiao is
oat al utnast inpartjoe` io tb`s` ejs`s, sa jcc jps
jr` `qujccy suitjdc`. ]b` MNEJ jp ejo d` bjrv`st`mio j siz` tbjt ljeicitjt`s eav`rjh` al tb` `otir` marsun
al tb` tbund. U`c`etiao al tb` jp m`p`oms njiocy ao
tb` eaomitiao al tb` maoar sit` (i`, il tb` p`miec` iotjet
ar il tb`r` is eaotusiao io tb` pivat paiot jr`j).
]r`jtn`ot al jo ucojr tip iokury al tb` tbund
pr`s`ots j sp`eijc ebjcc`oh`. ]b` ucojr tip is ao` al
tb` nast inpartjot tjetic̀ jr`js io tb` bjom jom
pravim`s j 5-paiot pioeb hrip jom g`y pioeb io datb j
m`ciejt` jom lare`luc ljsbiao. @xè cc̀ ot s`osary
luoetiao is tb`r`lar` o`e`ssjry lar oarnjc bjom
luoetiao jom tb` m`v`capn`ot al hrip str`ohtb. ]b`MNEJ jp bjs iomisputjdcy d`ean` tb` wargbars`
io ejs`s wb`r` tb` Nad`rh jp is oat suitjdc` lar
eav`rioh tb` m`l`et jom tb` eaos`rvjtiv` s`ni-
aeecusiv` n`tbam is oat eaosim`r`m jppraprijt`.
Oun`raus aptiaos `xist lar tb` r`eaostruetiao al
tbund tip m`l`ets. ]b` s`ni-aeecusiv` n`tbam bjs
`vacv`m iota tb` stjomjrm prae`mur̀ . D`ejus̀ tbis
t`eboiqu` pravim`s `xe c̀c`ot r`starjtiao al eaotaur,
vacun`, jom s`osidicity, it is suitjdc` lar nast snjcc
ta nimsiz` tbund tip m`l̀ ets. Lar cjrh`r, eanpc`x
m`l`ets, jp r`eaostruetiao is sticc us l̀uc. J drajm
jrnjn`otjriun al jps is jvjicjdc ,̀ rjohioh lran
iotriosie jps ta snjcc lr`` jps, wbieb ejo d`
eustaniz`m ta tb` r`quir`n`ots al tb` pjti`ot.
T@L@T@OE@U
:. C`nnao KJ, Kjois K@, Tabrieb TK. Ualt-tissu` iokurì s al tb`oh`rtip; n`tbams al `vjcujtiao jom tr`jtn`ot. Jo jcharitbnie
jpprajeb. Vcjst T`eaostr Uurh. 46627442(5);:60`̀ ::8`.
4. @vjos MN, D`rojrmis E. J o`w ecjssiejtiao lar oh`rtip iokuri`s.
K Bjom Uurh Dr . 4666740(:);02̀
8/18/2019 Management Thumb Tip Injuries_Germann_JHS 2015
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:5. Nad r̀h @. Jsp`ets al s`osjtiao io r`eaostruetiv` surh̀ ry al tb`
upp`r `xtr`nity. K Dao` Kaiot Uurh Jn. :9
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