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Applied Evidence
. 2013 June;62(6):300-304
Author(s):

Just because a finger injury looks benign doesn't necessarily mean emergency treatment is not required. Take our quiz to test your ability to tell the difference.

References

1. Hogan CJ, Ruland RT. High-pressure injection injuries to the upper extremity: a review of the literature. 2006;20:503-511.

2. Gonzalez R, Kasdan ML. High pressure injection injuries of the hand. . 2006;5:407-411.

3. Freiberg A. Management of proximal interphalangeal joint injuries. . 2007;15:199-203.

4. Perron AD, Brady WJ, Keats TE, et al. Orthopedic pitfalls in the emergency department: closed tendon injuries of the hand. . 2001;19:76-80.

5. Oetgen ME, Dodds SD. Non-operative treatment of common finger injuries. . 2008;1:97-102.

6. Anderson D. Mallet finger. . 2011;40:91-92.

7. Smit JM, Beets MR. Treatment options for mallet finger: a review. . 2010;126:1624-1629.

8. Goodson A, Morgan M. Current management of Jersey finger in rugby players: cases series and literature review. . 2010;15:103-107.

Some finger injuries require little more than icing; others are more serious, often emergent, conditions with outcomes that are dependent on an accurate diagnosis and rapid initiation of treatment.

The 5 cases that follow describe injuries with varying degrees of severity. Read each case and select the multiple-choice answer you think is most appropriate. Then read on to find out if you were right—and to learn more about the clinical presentation, diagnosis, and treatment for each type of injury.

CASE 1 A 45-year-old auto body worker walks into your office at 5:30 pm, just as your staff is closing up for the day. A few hours ago, he reports, he was spray-painting a car with a paint gun when he felt a sudden pain in his right index finger. His immediate thought was that he had torn something, but the pain quickly subsided. So he continued to work until about 45 minutes ago, when the pain became so intense that he knew he needed medical care right away.

Examination reveals redness and increased skin temperature on the radial palmar side of the proximal interphalangeal (PIP) joint of the index finger. Two-point discrimination is decreased to 10 mm, vs 5 mm on the same finger of the opposite hand. The patient can flex his PIP and distal interphalangeal (DIP) joints but complains of pain and stiffness. You obtain x-rays of the injuredfinger ( FIGURE 1 ).

WHAT'S YOUR NEXT STEP?

Send the patient to the nearest emergency department (ED), calling ahead to alert the ED staff that he’ll need to be seen right away. Update the patient’s tetanus immunization and start him on a broad-spectrum antibiotic. Put a dorsal splint on the injured finger in the “safe hand” position and schedule a return visit in one week. “Buddy tape” the index and long fingers and refer the patient to a hand surgeon.

Answer: Send the auto-body worker to the nearest ED and call ahead (A). The risk for amputation of a finger with a high-pressure injection injury is high, unless aggressive surgical debridement is done within 6 hours.

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» Life as a (grad) student » To Synthesize or to Buy? That is the question.

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on May 18, 2011 | Chuck Taylor All Star Ox Plimsolls In Brown 157601C Brown Converse MSyJGU

Einstein probably synthesized his own compounds. (Flickr user hernandezmariacristina)

Happy summer, everyone! Sorry for the cheesy title. Because I’m still an undergrad, I get the chance to take some pretty cool classes that have a little to nothing to do with chemistry. This can either be a nice break (i.e: Shakespeare, see title) or an unwelcome distraction (…Spanish). I’m soaking in as much diverse education as I can before I start specializing in my PhD. This is all besides the point.

Anyway, I wanted to pose a question. When you’re running a synthesis, an assay, or whatever else it is you do in your lab, and you require a reagent that is expensive and difficult to synthesize, do you spend days synthesizing it yourself, or buy it atridiculousprice from a manufacturer? From what I can gather, there are two camps. Tell me if I’m wrong. PIs/Professors are more likely to encourage grad students to synthesize everything from scratch, and the graduate students vice versa. Whether their opinion is born from distrust of the manufacturers, a desire to teach you (the student) some more synthesis, or plain sadism is up to debate. The advantage is that you get to gain some more experience in what is probably a very classic synthesis, helping you gain some ‘lab chops.’ The disadvantage, of course, that that you have to stop watching Futurama to synthesize this molecule that you could just buy.

I’ve recently had aninterestingexperience. I had bought a reagent from a manufacturer, expecting to use it as a positive control. For whatever reason, it wasn’t working. After around two weeks of frustrated testing, I found that the molar mass of my positive control didn’t match to mass it was supposed to be (by MALDI). So therefore, we got sent a faulty reagent. Kind of a bummer, right?

After this debacle, I resolved myself to synthesize it myself, spurning the multimillion dollar industry for my own two hands. After a week of synthesis and purification, I am a proud owner of a compound which has a molar mass that is too large for the compound I would’ve wanted to synthesize. I still haven’t run enough tests to see how far I’ve gone wrong, but as of now it seems possible that I’ve somehow messed up, which puts me at a unique crosscroads.

Do I synthesize my positive control again? It only took me a week, and is much less expensive than buying it from a manufacturer. Also, I can make gobs at a time (technical term), and I can only buy a small quantity. On the other hand, I could just buy it again and hope for this best. Sure, it’s much more expensive, but it’d be so easy! Plus, I could finish this episode of futurama.

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