A unique case of exploded hand syndrome with hand ischemia and multiple phalangeal neck fractures of all fingers: Case report

Abstract

Introduction: Although exploded hand syndrome is well described in the literature, only a few cases have been reported. A sudden compressive force to the hand leads to extrusion of the intrinsic muscles through burst lacerations in the skin. This case report has been reported in line with the SCARE checklist.

Case report: A 45-year-old male industrial worker sustained a crush injury to his right hand when a compressor plate hit the hand at the factory. Besides extrusion of the intrinsic muscles and multiple metacarpal fractures, two unique features were seen: fractures of the phalangeal necks and hand ischemia. The extruded muscles were excised, and all wounds were closed. Closed reduction (without fixation) was done to all fractures. Immediate mobilization of the fingers was done. A good outcome was obtained with this simple approach.

Discussion: Our case of exploded hand syndrome was unique in both presentation and management.

Conclusion: We demonstrate that a good outcome with closed reduction (without fixation) of fractures is recommended in cases of exploded hand syndrome with concurrent hand ischemia. The rationale behind this approach is the fear of further compromising the blood supply of the hand with open reduction and fixation of the multiple fractures.

Keywords: Fracture; Hand injury; Management.

Fig. 1

Appearance at presentation – note the extruded intrinsic muscle.

Fig. 2

A. X-ray at the time of presentation showing the fractures (see text for details). B. Close-up x-ray showing the undisplaced phalangeal neck fractures of the fingers.

Fig. 3

Range of motion at final follow-up. A. digital extension. B. digital flexion.

Fig. 4

X-ray at final follow-up.