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Outlines current management of upper limb conditions in primary care settings

This information is for primary care physicians and a general summary of current practice 

Please consult a physician directly for management of specific injuries  

Quaba Flap Case Study

Mechanism of Injury: Circlular saw slipped and lacerated the volar proximal phalanx of the dominant index finger

Injured Structures: Flexor Digitorum Profundus + Superficialias laceration, Proximal Phalanx Fracture + Large Skin defect

Consideration in Primary Care


  • The finger is well perfused, pink, turgor, good inflow and no congestion

  • Can be assessed by pricking the finger tip with needle if you are concerned with circulation BUT avoid needles that may injury the digital arteries


  • Asses neurovascular bundles - check sensation on both side of the finger


  • The skin severely traumatised

  • Good pictures of the finger (dorsal and volar) before dressing are useful for the ULQ surgeon

  • Use non-stick dressing such has mepitel

  • Immobilise in a resting plaster



  • Assess boney injury with plain x-rays and potentially CT scan if time permits. This helps with operative planning.

  • This patient had a highly comminuted proximal phalanx fracture


Patient expectation:

  • Reconstruction vs Amputation - let this discussion happen between the surgeon and patient to ensure patient expectation will be met


Operative Management

Proximal Phalanx Fracture

The comminuted fracture was fixed with multiple lag screws

FDP/S Tendon Lacerations

Both tendons were repaired using 6 strand suture techniques

Skin Defect

A Quaba Flap was used to cover the skin defect

This flap is based on a dorsal metacarpal artery

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One Year Post Surgery

This patient regained full extension, flexion, had a functional pinch grip and his grip strength was 31.3 kg

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