Our finger tip is a durable and sensitive structure through which we touch, feel, write, draw, and perform activities of daily living.
Injuries to the fingertips are common in accidents at home, work, and play. Fingertip injuries can be crushing, tearing, or amputating injuries to the tips of fingers and thumbs. Injury can include damage to skin (fingertip pulp), nerve endings, bone, or to the nail and nail bed. Fingertips are rich with nerves and are extremely sensitive. Without proper care, this injury can result in permanent deformity and persistent pain.
Causes
The most common cause is from crush injuries, for example, getting the fingertip caught in a door or machine. A sharp cut to the fingertip may also result in injury.
Symptoms
Fingertip pulp can sustained a bleeding wound from cuts or crush injuries. AS simple crush of the fingertip may result in a very painful collection of blood (hematoma) under the nail. More severe injuries can result in cracking of the nail into pieces, or tearing off of pieces of the nail and/or fingertip, and possible injuries to the adjacent structures.
Assessment
The hand surgeon will obtain an accurate history of the cause of the injury. He will examine the finger tip for severity of injury. X-rays are taken sometimes to look for associated fractures. However, the full extent of the injury may not be evident until adequate anesthesia (usually local) is given and the nail is examined with magnification in the operating theatre.
Treatment
The aim of treatment is to restore the normal structure of the nail, nail bed, the finger pulp and surrounding structures.
Simple hematomas are drained by making a small hole in the nail in order to relieve the pressure and provide pain relief.
Straightforward cuts are stitched back accurately. In case of amputation of the tip of finger, a local flaps of skin from neighbouring finger may be used to replace missing skin if the bone is exposed. Otherwise, the wound may be allowed to just heal on its own, or covered with a skin graft.
Nail bed cut need to repair accurately and repairing the nail bed usually restores alignment of many fractures of the fingertip. Larger fragments of bone may need to be pinned or require splinting to hold the bone together while the fracture heals. Missing areas of nail bed can be covered with nailbed graft taken from the same finger or from other digits.
Tendon injury will need repair, splinting or pinning.
Prognosis
The final appearance and function of the nail and fingertip depends on the ability to restore the normal structure. If the injury is sharp and can be repaired, a normal nail is likely. If there is more severe crushing of the nail bed, then there is a greater likelihood of nail bed scarring and subsequent nail deformity. It normally takes 3-4 months for the nail to grow to the tip of the finger.