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Abstract
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The revolution in industry and agriculture has led to a rise in the occurrence of hand injuries, which make up almost 10% of visits to hospital emergency departments.1-3 More than half of these injuries result from hands becoming trapped in active machinery.4 Accidents involving snap button machines can result in severe injuries, which may involve bone, tendon, muscle, nerve and vessel.5
We present two cases of work-related snap button injury to the index finger. Cases 1 and 2 (figures 1 and 2, figure 3), both of which presented with wound and crush injury to the right index finger with the button fixed to the pulp, involving soft tissue and the distal phalanx. Both patients arrived at the emergency department within an hour of their injuries, complaining of pain and compromised vascularity of the soft tissue distal and surrounding to the button. However, contamination was minimal. A plain radiograph (figures 4 and 5) of the affected hand and basic blood tests for surgery were performed. Both cases were given a course of injections of ceftriaxone with sulbactam as preoperative prophylaxis. After appropriate counselling, both cases underwent emergency surgery under regional anaesthesia for disengagement of the button. The snap button is composed of two rings as shown (figure 6), one with sharp prongs and one with slots for these prongs, which interlock when manually or machine applied to a cloth. Until the ring with prongs is cut, the system will not disengage, and if removal is attempted by pulling, it can sever the soft tissue that is caught in between the rings, resulting in the amputation of the affected part. The ring with prongs was cut with a K-wire cutter, and each prong was straightened individually. Both rings were then dismantled. The wound was debrided, and primary closure was performed in both cases (figures 7 and 8). After wound inspection, the patients were discharged on the third day after continuing antibiotics for 3 days. Both cases had uneventful recoveries and were able to return to work without any disability. Both patients had pain-free movement at the end of 1 month, with no further complications related to the wound or sensation (figure 9). However, the scar from the injury remained, but apart from the cosmetic issue, full functional recovery was achieved at the end of the month. Both cases were counselled and educated on the prevention of future accidents of this type and the necessary precautions to take...
Language: en |