Case 34-2010 — A 65-Year-Old Woman with an Incorrect Operation on the Left Hand  

Oleh:

Ring, David C. ; Herndon, James H. ; Meyer, Gregg S.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 363 no. 20 (Nov. 2010), page 1950-1957.
Topik: Case Study; Incorrect Operation

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2010.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Presentation of Case A 65-year-old woman was admitted to the day-surgery unit at this hospital for release of a trigger finger of the left ring finger. Approximately 3 months earlier, the patient was seen in the orthopedic clinic at this hospital because of pain and stiffness in the ring finger of the left hand. She reported that the finger intermittently “got stuck” in flexion. She had a history of coronary-artery and carotid-artery atherosclerosis, hypertension, diabetes mellitus, hyperlipidemia, and hypothyroidism. She had had a cholecystectomy in the past. Medications included nitroglycerin and nitrate preparations, metformin, levothyroxine, simvastatin, acetylsalicylic acid, and vitamins. She had no known allergies. She had been born in a Caribbean country and spoke only Spanish. She lived with her son. She did not smoke, drink alcohol, or use illicit drugs. On examination, there was tenderness in the palm at the base of the left ring finger over the A1 pulley of the flexor tendon sheath and a slight flexion contracture of the proximal interphalangeal joint of the left ring finger. There was snapping of the left ring finger with flexion and extension. Motor and sensory function and tendon balance were normal, and there was no angular or rotational deformity. A diagnosis of idiopathic trigger finger (stenosing tenosynovitis) was made. The patient elected a trial of dexamethasone, which was injected locally. At follow-up 8 weeks later, she reported no improvement in the joint symptoms. The examination was unchanged. The risks, benefits, limitations, and alternatives of operative and nonoperative treatment were discussed. The patient decided to proceed with surgery. Ten days later, the patient was admitted to the day-surgery unit, and carpal-tunnel-release surgery was performed without complications. Immediately after completing the procedure, the surgeon realized that he had performed the incorrect operation.

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