Management of fingertip injuries
- Richard A Saladino, MD
Richard A Saladino, MD
- Professor of Pediatrics
- University of Pittsburgh School of Medicine
- Peter Antevy, MD
Peter Antevy, MD
- Pediatric Emergency Department
- Joe DiMaggio Children's Hospital
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Nail bed injuries and fingertip avulsions occur frequently and may have significant associated functional or cosmetic morbidity. These injuries are commonly treated in an outpatient setting. Nail bed lacerations require careful repair and measures to preserve the nail folds and germinal matrix. Complete fingertip avulsions require debridement, cleansing, and local wound care.
The repair of nail bed lacerations and fingertip avulsions are reviewed here. The management of subungual hematoma is discussed separately. (See "Subungual hematoma".)
MECHANISM OF INJURY
Isolated nail bed injury typically occurs as a result of direct blunt trauma (eg, crush in a door jamb). A nail bed injury almost always accompanies a partial or complete fingertip avulsion [1-3]. Fingertip avulsions often occur in the setting of door closure upon the finger, either along the edge of the door on the side of the hinge or the latch. Most avulsions are partial avulsions of the fingertip, although full amputations are not rare.
Fingertip avulsions are also caused by knives, slicers, exercise equipment (eg, treadmills, exercise bicycles), power tools, and lawn mowers. In contrast to adults, complete or partial avulsions heal extremely well in children especially before adolescence. In particular, the literature indicates that children younger than two years of age are very likely to demonstrate complete distal tip regeneration after amputation when managed without repair [4,5].
Proper management of fingertip injuries requires knowledge of anatomy of the nail bed as well as familiarity with the motor and neurovascular anatomy of the finger (figure 1).
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- MECHANISM OF INJURY
- INDICATIONS, CONTRAINDICATIONS, AND PRECAUTIONS
- Indications for subspecialty consultation or referral
- Patient counseling and informed consent
- Local anesthesia, analgesia, and sedation
- Fingertip skin avulsion
- Nail bed injury and repair
- Partial fingertip avulsion or amputation
- Complete fingertip avulsions or amputations
- ADDITIONAL CONSIDERATIONS
- Antibiotic therapy
- Tetanus prophylaxis
- Wound care and patient instructions
- SUMMARY AND RECOMMENDATIONS