Finger dislocations and auto-irradiation
Doctors are trained to diagnose and treat conditions that patients come to them with. But what happens when the doctor themselves are unwell? Discussions with colleagues often reveal stories of self-prescription and treatment. Usually, this is limited to antibiotics and regular medication use. Recently, I was confronted with a self-treatment situation as a GP registrar in my 2-doctor country town.
However, the precedent for medical practitioners treating themselves is not a new one. In 1961, Leonid Rogozov performed surgery on himself as the only doctor on an isolated Russain Antarctic station. He recognised the symptoms of appendicitis and dutifully performed an auto-appendicectomy. Luckily he had the equivalent of surgical interns helping, a driver and meteorologist holding instruments and a mirror.
Alas, my story is not as hardcore.
It was the fourth round of Mid West football in country SA and I was lining up on the wing for the Wudinna United B grade team. Even though the two teams playing were bitter rivals, first quarter went by without incident. However, halfway through the second quarter, I went to punch the ball coming down into a pack of players. As my 2nd finger hit the Sherrin, there was a pop then numbness. Looking down at my right hand it was obvious that I had dislocated the proximal interphalangeal joint. Luckily, I was able to easily reduce the finger as soon as it happened. There was surprisingly little pain, perhaps the adrenaline was covering that? A trainer had seen me holding my fingers and came over. “What do you want to do doc?” And I thought they were the experts! I had seen enough jarred fingers in the city emergency departments to get something started. Some tape did the trick in buddy strapping to my middle finger and I grabbed a couple of ibuprofen. At half time one of the other trainers sidled over and looking at my two fingers strapped together said, “hope you’re not offended if I cancel my rectal exam this week mate.”
Back at the hospital, I took my own x-ray and interpreted the film. No big or intra-articular fractures….that I could see anyway. Perhaps just a slight little chip off the volar aspect of the base of the middle phalanx (left, happy for radiology comment!!). Certainly not enough to warrant anything to drastic as far as surgery went. So I decided that the management should be continued continued as RICE and NSAID-based analgesia. But it made me wonder, if in my post game haze, I had followed proper treatment of finger dislocations for this injury? Certainly I had seen cases in ED where you could always ask for a ortho/plastics opinion. But in the country this isn’t as easy. So what would have been the indications to get my x-rays and finger looked at properly. Next week, I will discuss the equipment and alcohol necessary to take out your own appendix*
Searching around, I found some quick points regarding proximal interphalangeal joint (PIPJ) dislocations:
- Vast majority are dorsally dislocated
- Caused by direct blow (usually a ball) to the tip of the finger (axial load)
- Put in ring block if reducing in ED, but patient can try to self reduce easily as soon as it happens
- Reduced by slight traction and pressing on the distal end of middle phalanx
- Murtagh suggests holding onto the distal finger and asking the patient to lean backwards
- Ortho/plastics referral may be required if
- Lateral instability
- Fractures involving base of middle phalanx
- Extensor mechanism rupture – buttonhole or mallet finger deformity
- If no worrying signs: buddy strap to adjacent finger for 3-6 weeks to avoid hyperextension
*Fortunately, prospective Antarctic doctors now have a prophylactic appendicectomy.
- Murtagh’s General Practice
- Roberts and Hedges, Clinical Procedures in Emergency Medicine