0:01

The history on this one was a 50-year-old man,

0:05

just a youngster with a history of a

0:08

small finger laceration while cutting a wood saw,

0:12

while cutting with a wood saw.

0:14

You can tell I, I definitely failed shop,

0:17

but I did well in art.

0:22

Let's see. So let's get to

0:26

that little baby finger right there,

0:28

and I'm gonna blow it up a little bit

0:33

and then put up an axial.

0:36

That's probably not the one I should have

0:38

selected, nor that one.

0:40

But this one, you've got this rather large

0:44

defect here,

0:49

and I think the sagittal tells the entire story.

0:52

It's a pretty straightforward case

0:54

unless you haven't seen much finger

0:57

and it's a flexor tendon injury.

0:58

And remember, you know,

1:00

the tendons aren't always gonna be straight.

1:02

They're gonna be a little bit oblique.

1:04

So to track them, you have

1:06

to work your way across the image, especially, you know,

1:08

if they retract into the palm,

1:10

it can be a little bit tricky.

1:13

Now, Letty

1:14

and Packer, uh, described the classification system

1:17

for these types of injuries.

1:19

I think in 2012.

1:21

Uh, they were not couple, one from New Jersey,

1:24

one from North Carolina.

1:26

And um, this is a Leady packer.

1:28

Three, I'm not so much interested in you learning the

1:31

classification right now, but I would encourage you all

1:34

to go back and google that article.

1:36

Uh, it's reproduced, uh, in Radiographics too,

1:39

in a segment on flexor tendon injuries.

1:41

But when you pull off from the distal phalanx, a piece

1:46

of bone, you have things that get in the way.

1:49

So one of the things that gets in the way is,

1:52

is the distal pulling.

1:53

So either the A five pulley,

1:55

or more commonly the A four pulley gets in the way

1:58

in lesions like this.

2:00

And the lei packer three. What's a lei packer?

2:02

One, that's when you have retraction without a piece

2:05

of bone, and it goes in, into the, the mid palmer region.

2:10

What's a leti packer?

2:11

Two, that's when you get held up at a three, uh, at,

2:15

at at pulley, A three,

2:16

and you've got a piece of bone, a leti packer.

2:19

Four is when you tear here,

2:20

but you also separate this from a fragment of bone.

2:24

And now there's even a leti packer five

2:28

when you have an avulsion.

2:29

But you also have either a simple

2:31

or comminuted fracture elsewhere in the distal phalanx.