Fingertip injuries are unfortunately a common occurrence in many different places of employment. They are especially common in young men who perform manual labor. The fingertip is exposed in a variety of occupations where it can be crushed by heavy objects, lacerated by knives, or injured by power tools such as table saws. These injuries can lead to damage to the bone, tendon, nerve, nail bed, finger pad (pulp), and skin. Tendons (both flexor and extensor tendons) are the key structures that bend and straighten the finger. Nerves provide feeling to the tip of the finger, while the nail bed (germinal matrix) is responsible for making the nail.
The relative lack of soft tissue at the tip of the finger, as well as the presence of the nail bed, makes these injuries often complicated to treat. While some people may disregard the importance of the nail itself, it plays a key role in the function of the hand. Nails protect the fingertip, provide a counterforce when picking up small objects, and contribute to the tactile sensation of the fingertip.
When evaluating an injury to the fingertip, the degree of damage as well as the physical demands of the patient are taken into account when devising a treatment plan. Blood often collects underneath the nail(subungual hematoma) after a crushing injury. When there is a significant amount of blood, as well as a break of the underlying bone, surgery is often recommended to drain the hematoma, wash out the open fracture, and to repair the nail bed. The fracture itself is often amenable to nonoperative treatment with a splint - only occasionally requiring surgical treatment with a metal pin or screw.
Some fingertip injuries can be treated with simple daily dressing changes with antibiotic ointment. These patients often only have soft tissue loss of the fingertip, without the severe damage involving bone, tendon and nail bed as described above. With some persistence, the end result of this non-surgical treatment in select patients can be excellent.
While most patients with fingertip injuries are able to regain much of their pre-injury function, it is important to note that many of these patients will report residual numbness, cold sensitivity, and nail growth abnormalities. Finally, the involvement of a certified hand therapist is an integral part of optimizing functional outcomes for the long term with or without surgical treatment.
Author: David Katz, MD
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