Mohammed Farid ¹, Hussain Selmi ², Patrick Goon ³

¹ Department of Plastic Surgery, The Royal London Hospital NHS Trust, Whitechapel Road, London, United Kingdom, E1 1BB         e-mail: mohammed.farid@gmail.com
² Department of Plastic Surgery, Lister Hospital, Coreys Mill Lane, Stevenage, United Kingdom, SG1 4AB       e-mail: hussainselmi@gmail.com
³ Department of Plastic Surgery, Lister Hospital, Coreys Mill Lane, Stevenage, United Kingdom, SG1 4AB     e-mail: patgoon@googlemail.com

Introduction

Bone injuries have been associated with high-voltage injuries either as a primary cause or secondary to traumatic impact. The proximal appendicular skeleton, particularly the humerus is more common fracture site compared to distal parts such as carpal, metacarpals and phalanges. Furthermore, children may be more susceptible to fractures due to electrical injures.  We present an unusual case of a low-voltage domestic full thickness burn injury with associated lunate fracture dislocation that underwent surgical management. The aim was to achieve a satisfactory outcome, and retain normal hand function with appropriate rehabilitation.

Case Report

A 67 year old Caucasian female, right hand dominant, who presented with a full thickness electrical burn (1 cm²) left thumb entry wound and right thumb exit wound. The injury was sustained from low-voltage domestic electrocution (220 volts) while vacuum cleaning. She was thrown across the room and could not recall the immediate impact but reported wrist pain. Computed tomography (CT) imaging revealed a left peri-lunate dislocation and volar lunate fracture. The immediate management included resuscitation and cardiology input to ensure the patient was heamodynamically stable prior to any surgical intervention. Eleven days post injury, she underwent open reduction and internal fixation with Kirschner wires (K-wires) to capito-lunate and luno-capitate joints. The sacpho-lunate ligament was repaired intra-operatively. Post operatively a thermo-plastic splint was fitted and K-wires were removed after 8 weeks. The rehabilitation protocol with hand physiotherapist lasted for 8 months together with on-going out-patients clinic attendance. Overall the patient was pleased with the outcome as she regained her normal hand function following rehabilitation.

Conclusion 

Low voltage domestic burns are not to be under-estimated as a cause of complex hand fractures due to direct trauma or electrocution. These injuries may require extensive surgical repair for unstable combined fracture dislocations.  The key for a positive outcome is related to on-going rehabilitation with physiotherapy input to ensure the regaining of normal hand function.

Key Words

Hand Injury, Electrical Burn, Rehabilitation

Biography

I graduated with MBChB from the university of Birmingham , England in 2009. Subsequently, i did my plastic surgery theme core training in Yorkshire region till 2013. During this time, i achieved an MSc in surgical sciences with University of Edinburgh . I have been a registrar in plastic surgery for 10 months and aim to pursue a career in burns. I spend my free time travelling, cycling, reading and keeping fit.