Fingertip Injury

Definition
• Fingertip Injury
 Classifications
• Allen
• Tamai
• Ishikawa
• Allen classification
– Type 1 : involves only the pulp
– Type 2 : involves the pulp and nail bed
– Type 3 : includes partial loss of the distal phalanx
– Type 4 : injury proximal to the lunula
Allen Classification
 CAUSES
• Can be caused by an injuries, such as
– A sharp cut
– Crushing injury
– Tearing injury
– Other injury mechanism are sudden flexion or extension
leading to distal tendon avulsion injury
• An injury can damage any part of the fingertip, including
– Skin and soft tissue
– Fingertip bone (distal phalanx)
– Nail and underlying nailbed
 Medical History
• How and when did your injury occur?
• Is the injured finger on your dominant hand?
• What do you do for a living?
• What are your recreational activities?
• Do you smoke or use tobacco products?
• Have you ever had hand problems caused by
osteoarthritis, diabetes, rheumatoid arthritis, or any
other medical condition?
• Is your tetanus immunization up-to-date?
 Physical Examination
• Patients present primarily with pain, inability
to use the affected digit, or bleeding.
• Physical examination should be done in a
controlled setting with appropriate lighting to
allow for visualization of the injury and a
proper assessment based on the history.
• Findings may reveal lacerations, closed or
open fractures, and amputations of the tip.
 Evaluation
• Should assessing for :
– Sensation
– Range of interphalangeal joints
– Capillary refill
• X-rays of the affected digit and hand with two
to three views
 Treatment
• Primary goals of treatment include pain relief
and attempting to reduce bleeding
• The management is based on the type and
severity of the injury
 Fingertip Injury Allen algorithm
• Algorithm management
 Subungual hematoma
• Most commonly caused by a crushing-type
injury causes bleeding beneath nail
• Treatment
– Drainage of hematoma
– Nail removal
 Nail Bed Laceration
• Laceration of the nail and underlying nail bed
– Usually present with the nail intact and subungual
hematoma greater than 50%
• Treatment
– Nail removal. Nail bed repair
 Avulsion injuries
• Avulsion of nail and portion of underlying nail bed
• Mechanism : usually caused by high energy
injuries
• Associated condition : commonly with distal
phalanx fracture
• Treatment :
– Nail removal
– Nail bed repair
– +/- Fx fixation
 Complication
• Loss of nail
• Deformity of the finger
• Loss of fingertip
• paresthesias