Glass cut to the palm of a 1 year old
This is the story of a 1 year 4 month old twin who was playing with his brother when the glass he was carrying fell and shattered. As this happened the little one fell onto one of the chards which pierced his palm. The skin injury was 1cm across and when they presented to the first emergency department they wanted to simply stitch the wound closed. His folks then decided to call their paediatrician and they were referred to Sandton ER. The position of the finger immediately gives away an injury more severe than just a skin laceration. Surgical exploration revealed that both tendons to the middle finger and the two common digital nerves were cut. It is important to never underestimate the damage a glass cut can do even if the skin wound may look benign or minuscule. The tendons and nerves were repaired under magnification and will take a few months to heal. Sensory testing in children is very difficult as they do not have the ability to rate or compare sensory inputs other than moving away from pain. Therefore it is important in the recovery period, that the parents know that should the insensate finger touch a hot surface that a burn injury may be caused without the child realising it. The hand will be kept in a dorsal flexion block splint/cast for 3-4 weeks and until all wounds have healed well. Once that splint has been removed, the rehabilitation will move directly to full active movements as no supervised therapy is possible. Removable splints are not feasible in this age group. Parent education is key.
