Staged Reconstruction for Dorsal Hand and Wrist Shear Injury: A Case Report

Dorsal hand shear injuries present complex challenges for surgeons in addressing soft tissue coverage, extensor tendon injuries, and bone loss. This case study examines the inherent challenges associated with the treatment of a severe injury to the dorsum of the hand, as well as the selected treatment approach.

A 41-year-old male experienced a severe injury to the dorsum of his left hand following a road traffic accident. The injury involved skin loss from the wrist to the metacarpophalangeal joints, complete loss of the extensor digitorum communis tendons and extensor indicis proprius, significant bone loss in all metacarpal and carpal bones, and instability in the distal radioulnar joint. Multiple debridement and reconstruction surgeries were performed, leading to a satisfactory functional outcome.

There are very few publications addressing complex dorsal hand injuries with follow-up lasting more than 10 years. This article addresses a complex dorsal hand injury and describes steps taken for management with long-term follow-up and acceptable functional outcome and patient satisfaction. A comprehensive understanding of the pathology and extent of the injury is crucial in developing an effective treatment plan for dorsal hand and wrist shearing injuries. Successful management depends on the knowledge and application of management principles and alternative approaches to address the diverse range of possible injuries involved to restore a functional hand.