By Tedler D. Depaynos, MD
It was nearly dawn and the morning light was about to end the night when the male patient was brought to the emergency room (ER). Despite his strong alcoholic breathe, he was obviously in pain. He came accompanied by his wife with his left hand raised and covered with a white bloodied cloth
They just celebrated the birthday of a co-employee with over flowing alcoholic bottles and “pulotan,” the “Sagada Lunch” specialty, when they all departed just after midnight. He was with his service motor cycle rushing home and when he tried to overtake a heavy loaded SUV, the left handle of his bike hit the side of an incoming truck. It was good that he was not thrown around and probably the truck driver did not even notice that they collided because the truck proceeded with its slow pace and did not stop. He suddenly lost his elated feeling and slight dizziness and knowing that it was his fault, he just proceeded home.
His fifth finger was literally crushed and the tiny bones were exposed and protruding. Luckily, it was only the soft tissues that were severely damaged and the finger bones were just with cracks and dislocated as confirmed by x-rays. It was classically a minor open fracture.
When bones in these cases are exposed, the danger of infection called osteomyelitis is great. Compared to soft tissue infections it is more difficult to treat and anti-biotic intake would take a much longer time. Hence, prevention is a must.
Under adequate anesthesia, the crushed finger was debrided and cleansed thoroughly. It was meticulously repaired after the dislocated finger bones were properly set. In more extensive open fractures where bigger bones are involved, repeated debridement may be required and closure of the soft tissues are done only when the probability of infection is already nil.
Although the blood supply appeared to be adequate the danger of amputation was explained to the patient in case gangrene unfortunately occurs especially if infection sets in despite the massive antibiotics. With a wide smile the attending MD advised the patient that anyway he still would have four functioning fingers and still would be able to wheeze with his service motorcycle without inhibitions.
The incident was a very painful and a wake up lesson to the patient because it was his first time to be involved in a vehicular accident. He not only promised himself but warned others not to drive a motor vehicle especially a motorcycle when tipsy. He was very thankful that his injury appeared minor for he realized that he could have even lost his life! He had been driving a motorcycle for quite some time and he admitted that wheezing and over taking with a motor bike was exhilarating and many had incurred major injuries and disabilities. Actually he silently shed tears when his wife was holding his hand at the ER while carrying their baby.**
