Patient’s Finger Impaled on a Door Handle

SavageGlow · #1 ● 02-22-2023, 12:12 AM

A 90-year-old man, with Parkinson’s disease, presented to the emergency department with a penetrating finger injury that was caught in the door-handle after a fall. He couldn’t recall the detailed mechanism of fall, but he lost his balance and fell backwards while holding the door-handle with his right dominant hand. The handle had passed through and through the palmar aspect of the proximal phalanx from medial to lateral aspect in his right middle finger (figure 1). The paramedics had unscrewed and taken off the door handle from the door which was still attached to the finger. On examination, he was able to move his middle finger and had no distal neurovascular deficit. The capillary refill time was less than 2 s and there was minimal bleeding from the wound. There was no fracture in the hand radiograph. After a preliminary assessment, the impaled object was removed successfully under a digital nerve block using an aseptic technique in the emergency department and the wound was then irrigated with normal saline under pressure. His tetanus vaccination was updated and a prophylactic antibiotic of co-amoxiclav 625 mg was administered. The wound was then reviewed after 48 hours and a delayed primary closure was performed. The patient had regained good hand function after physiotherapy and the wound healed unremarkably at the follow-up.