FINGER TIP INJURIES
Fingertips may be exposed to many different types of trauma. Although it is a small part of the hand the injuries to fingertips may affect almost all functions of it. Important components of the fingertip are the pulp, the nail and bony structure. Cuts, compressions and crush injuries are most frequent injuries. Flexion-extension, circulation and sensation distal to the injury are evaluated by physical examination. If necessary, X ray studies taken from different views helps to show us fractures and/or luxations.
After crush there may be no disruption of integrity of the tissues, but some blood under the fingernail is observed. First, distal phalanx fracture should be ruled out by radiologic studies. If there is no problem with bone, this blood should be evacuated by needling to reduce severe pain. If the nailbed is broken, it should be repaired using stitches after removing the nail matrix. Missing parts up to half of whole nail bed can be completed from the same finger. For more extensive defects toes can be utilized. For this aim, only upper parts of the nailbeds are used to not leave donor side morbidity.
Nondeplased fractures can be treated with splints or casts, whereas deplased ones may need to be fixed by temporary metal pins.
Loss of soft tissue coverage should be replased if it is bigger than it can heel by itself(secondary healing). Skin graft can be taken from different side of the body. Inner part of the wrist and upper arm are mostly preferred sides for this reason. If bone and/or tendon is exposed in the defect then a flap coverage is need from the same or adjacent finger.
In some occasions, the completely amputated fingertip may just be sewn back on, either repairing the blood vessels microsurgically(replantation) or preparing it as a composite graft.
Fingertip injuries shouldn’t be ignored since they may impair the usage of the whole hand for a long period.