Acromutilation of the Fingers Following Severe Burns

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Abstract
Eight weeks after magnesium burns, 2 patients were referred to the X-ray Department of St. Francis Hospital, Lynwood, Calif., for roentgen examination of the hands. The changes noted were peculiar enough to invite presentation. It is the purpose of this paper to describe these cases since no reference to similar defects was found in the radiologic literature. Case Reports Case I: J. G., a 22-year-old white male, was seen in the emergency room immediately following an explosion at his work, a few blocks away. A 50 per cent second- and third-degree burn involving the hands, face, neck, chest, arms, and back was recorded. Following emergency treatment the patient was taken to surgery for débridement. The fingernails were removed. The skin of the forearm and of the dorsum of the hands and fingers was hanging in shreds, but the bone was not exposed. Subsequent repeat débridement including sharp dissection of necrotic areas, especially on the dorsum of the distal two-thirds of the fingers, was performed. A week later Pseudomonas and beta-hemolytic Streptococci were cultured from the burn surface. After another week a split-thickness skin graft from the thigh to the dorsum of both hands and fingers was made. The index finger showed necrosis of the tendon over the distal joint. In two weeks the grafts had taken almost 100 per cent. There were granulated areas over the tufts of the fingers. Roentgenographic examination eight weeks after injury revealed the findings to be described below and reproduced in Figures 1–4. The patient has subsequently received physiotherapy and has regained considerable strength and function of his hands and fingers, but there is no change in the bone defects even as late as six months after the accident. Case II: B. R., a 21-year-old white male injured in the same explosion, was seen in the emergency room with a 40 per cent second- and third-degree burn of his entire torso, face, neck, hands, and arms. At initial débridement it was noted that the burns on the forearms and hands were probably of third degree, as “the skin peeled off these areas like a glove and the nails came along with the peeled skin.” After a week, Pseudomonas and beta-hemolytic Streptococci were cultured from the obvious infection. Re-débridement, with sharp dissection of the distal two-thirds of the fingers, was performed. The burn was seen to involve the extensor tendon slips. Three weeks later this area was grafted, but the graft failed to take. The procedure was repeated, and six weeks after injury the fingers on both hands showed granulating areas. The interphalangeal joints of the left index finger were open and draining through the granulation tissue. There was obvious loss of the extensor tendon and capsular substance at these points. No exposure of the tips of the phalanges was identified. Roentgenographic examination was made in order to evaluate a septic arthritis.

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