Fingertip Injuries Health Article

Treatment

Amputation with bone and underlying tissue intact and a wound area 1 cm or less should be cleaned and treated with a dressing. With these types of wounds healthy tissue will usually grow and replace the injured area. Larger wounds may require surgical intervention. Puncture wounds should be cleaned and left open to heal. Patients typically receive antibiotics to prevent infection. A procedure called trephining treats subungal hematomas. This procedure is usually done with a straight cutting needle positioned over the nail. The clinician spins the needle with forefinger and thumb until a hole is made through the nail.

Patients who have extensive crush injuries or subungal hematomas involving laceration to skin folds or nail damage should have the nail removed to examine the underlying tissue (called the matrix). Patients who have a closed subungal hematoma with an intact nail and no other damage (no nail disruption or laceration) are treated conservatively. If the fracture is located two-thirds below the fingertip immobilization using a splint may be needed. Conservative treatment is recommended for crush injuries that fracture the terminal phalanx if a subungal hematoma is not present. Severe fractures near the fist circular skin crease may require surgical correction to prevent irregularity of the joint surface, which can cause difficulty with movement. Injury to a flexor tendon usually requires surgical repair. If this is not possible, the finger and wrist should be placed in a splint with specific positioning to prevent further damage.

Prognosis

Prognosis depends on the extent of traumatic damage to the affected area. Nail lacerations that are not treated may cause nail deformities. When amputation is accompanied with loss of two-thirds of the nail, half of the fingers develop beaking, or a curved nail. Aftercare and follow up are important components of treatment. The patient is advised to keep the hand elevated, check with a clinician two days after treatment, and to splint fractures for two weeks in the extended position. Usually a nail takes about 100 days to fully grow. Healing for an amputation takes about 21 to 27 days. This markedly decreases in elderly patients, primarily due to a compromised circulation normally part of advancing age.

BOOKS

Rosen, Peter. Emergency Medicine: Concepts and Clinical Practice. 4th ed. Mosby-Year Book, Inc., 1998.

Townshend, Courtney M., et al. Sabiston Textbook of Surgery. 16th ed. W. B. Saunders Company, 2001.

PERIODICALS

Shetty, P., S. Dicksheet, and T. Scalea. "Fingertip Injuries: Immediate Reconstruction versus Delayed Healing." American Journal of Emergency Medicine 14 (Jan. 1996).

ORGANIZATION

American Society of Plastic Surgeons. 444 E. Algonquin Rd., Arlington Heights, IL. (888) 475-2784.

Laith Farid Gulli, M.D.

KEY TERMS

Distal—Movement away from the origin.

Flex—To bend.

Laceration—A cut in the skin

Phalanx—A bone of the fingers or toes.

Tendon—A structure that connects a skeletal muscle to bone.