Fingertip injury covers cuts, accumulation of blood (hematoma), bone breakage, or
amputation in the fingertip.
Causes of Fingertip injury
Accidental amputations will usually result in profuse bleeding and tissue loss.
Injuries to the pulp can occur as from fast moving mechanical instruments, such as drills.
These injuries may puncture the pulp. Injuries such as a subungal hematoma are caused by a
crushing type injury. Fractures typically occur as the result of crushing injuries or
tendon avulsion. These crushing injuries are frequently caused during sport injury and can
be treated by simple interventions such as immobilization or more complex
procedures if tendons are affected (the trauma is then treated as a tendon injury).
Fractures can cause pain and, depending on the extent of swelling, there may be
some restriction of movement. Tendon injuries can be caused when the terminal joint is
exposed to force flexing motion (moving the finger toward the palm) while held straight.
Diagnosis of Fingertip injury
The attending clinician should evaluate the injury in a careful and systematic manner.
The appearance of the hand can provide valuable information concerning presence of
fractures, vascular status, and tendon involvement. Bones and joints should be evaluated
for motion and tenderness. Nerves should be examined for sensory (feeling sensations) and
motor (movement) functioning. Amputations usually profusely bleed and there is tissue
loss. The wound is treated based on loss of tissue, bone, and wound area. Injuries to the
pulp can be obvious during inspection. Subungal hematoma usually present a purplish-black
discoloration under the nail. This is due to a hematoma underneath the nail. Radiographs
may be required to assess the alignment of fractures or detect foreign bodies. Patients
usually suffer from pain since injuries to the fingertip bone are usually painful and
movement may be partially restricted due to swelling of the affected area. Tendon injuries
usually result in the loss of ability to straighten or bend the finger.
Treatment of Fingertip injury
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.