Our client, a 39 year old male, worked as a welder for a construction contractor. One day, while in the course and scope of his employment, he suffered an injury to his left index finger when his glove got caught in a grinder and the grinder sliced his left index finger. Our client went to an occupational medical center at the request of his employer. He was seen by a nurse practitioner for the treatment of his lacerated finger. The nurse practitioner gave the diagnosis of a laceration of the proximal joint index finger. The site was cleaned and sutured, and our client was told that he could return to work.
Two days later, our client presented back to the occupational medical center with complains of index finger pain and swelling. He was seen by the same nurse practitioner who noted the swelling. The nurse practitioner prescribed antibiotics and told him to keep the hand elevated. In ten days, our client returned to the occupational medical center complaining that his finger was still swollen and now had a limited range of motion; again, the nurse practitioner simply released him to work on light duty. Eighteen days after the initial incident, our client reported back to the nurse practitioner with pain and swelling of his left index finger. This time the nurse practitioner ordered an x-ray of the hand. The x-ray showed a flexion deformity of the PIP joint. The nurse practitioner referred him to see a specialist. In all of our client’s visits, he was never referred to a hand specialist or an orthopedic specialist for the care and treatment of his lacerated left index finger. The nurse practitioner never considered an injury to a tendon.
The next day, our client presented to an orthopedic surgeon for a consultation regarding the lacerated finger. Radiographic studies revealed a flexion deformity at the proximal interphalangeal join and hyperextension at the distal interphalangeal joint consistent with a boutonniere deformity. The orthopedic surgeon immediately determined that our client had suffered an injury to the tendon and referred him to see a hand specialist. The same day, the hand specialist examined our client and determined the he had sustained a central band laceration of the extensor tendon of the left index finger, boutonniere deformity of the left index finger and cellulitis of the left index finger. The hand specialist recommended surgery for debridement and exploration of the laceration. Postoperatively, our client followed up with physical therapy and wearing a splint as ordered. Our client also had to see a wound care specialist.
It was the opinion of the hand specialist that had our client been referred to him earlier, the surgery would have been less extensive and the client would have had a better result. He also felt that the breakdown over the PIP that required wound care treatment was caused by the devascularization of the tissue from the delay. The hand specialist stated that had the nurse practitioner referred him for treatment earlier, the extensive repair would not have been necessary.
Due to the delayed treatment of our client’s laceration, he suffered through extensive and painful surgery, physical therapy, and wound care. Our client now has a permanently deformed left index finger. He now has trouble putting on shoes, tying shoes, getting dressed, and casting a fishing pole. He must hold his finger out of the way when performing any of these activities. Weather changes now cause our client pain, and he is not at a greater risk of arthritis. Through the use of physician testimony, Todd Townsley was able to favorably settle this claim.
