Effectiveness of Nerve Wrapping and Capping with a Nerve Conduit and Blocking Splint Therapy for a Painful Neuroma at the Metacarpophalangeal Joint

A 42-year-old man suffered an avulsion amputation of his right middle finger. He had undergone several surgeries since the age of 24, including amputation plasty and implantation of the injured nerve into fat and bone, but had difficulty returning to work due to persistent severe pain. He underwent nerve capping with an artificial nerve conduit at a university hospital, and his symptoms improved slightly, but immediately flared up again. Therefore, he was referred to our hospital and was treated with a blocking splint in addition to resection of the traumatic neuroma, covering with an artificial nerve conduit and wrapping with an adiposal flap. The lumen of the conduit was observed without collapse until it was resorbed, and he returned to work without pain 10 months after surgery. The blocking splint to an angle that preserves the lumen of the conduit was useful for artificial nerve surgery near the joint. Level of Evidence: Level V (Therapeutic).