A month after a young man had injured his thumb in a machine which fills “pure water sachets,” he came to BMC. He had been dressing his wounds at another hospital, but he had not seen any improvement. The skin, soft tissue and tendon on the nail side of his thumb overlying the knuckle joint were gone. His bones, grey and cracked, were exposed. The joint was dislocated. The edges of the skin were pink and beefy with purulent fluid draining from under the bones. His fingernail appeared healthy. Sensations were intact at the tip of his thumb. The palmar side of the thumb was intact.
Knowing that the tendon had already been destroyed, I knew he would never regain full function of the thumb. I discussed with him the possibility of him losing his thumb, but that I would do all I could to salvage it.
We cleaned it well and I explored the wound under local anesthesia. The end of the first finger was dislocated and the bone was clearly not healthy, so I cut off the end of that bone. I cleaned out the dirty tissues and started to close the wound. The edges of the wound were too far apart to close completely. Instead, I splinted the thumb and then bridged the gap with thick sutures.
Over time, the wound slowly closed completely, but then it opened again to drain purulent fluid little by little. An X-ray revealed that part of the bone that I left in place had died and the body was trying to get rid of it.
Again, under local anesthesia, I made a small incision and removed two small pieces of bone that were pushing their way up through the skin. We cleaned out the tract and allowed it to heal. He is no longer able to bend the thumb, but he is still able to use it in opposition to his other fingers.
His smile showed me how very grateful he is to have his thumb. His final question was “when can I return to playing goalie for my football (soccer) team?”