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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 November 24; 335(7629): 1093.
PMCID: PMC2094145

An all-round thumbs up

Gavin Huw Owen Brigstocke, orthopaedic senior house officer, Royal Surrey County Hospital, Guildford

A 43 year old street cleaner was brought to her local emergency department in the early hours of the morning by a concerned set of firefighters. The patient had inadvertently trapped her non-dominant thumb in the end of a standpipe. The activated self-locking mechanism had clamped on her thumb within the heavyweight tubing, and the fire crew had been unable to prise her free.

After the administration of a digital nerve block and some fairly hefty head scratching, a far fetched plan came to mind. The standpipe had two holes (for a cross bar) about 10 cm from the locked thumb. By inserting a fine-bore optic naso-endoscope into one of the holes, I was able to see the pin compressing the patient's thumb and simultaneously introduce a right-angled Lahey clamp. This enabled me to retract the pin, and the patient slid her thumb free to a resounding round of applause from the attendant fire crew.

The benefits of an old fashioned basic surgical training shone through as my accident and emergency, ENT, and general surgery skills combined for an all-round thumbs up.

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