Fingertip avulsion: Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
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**Instruct patient to soak fingertip in antibacterial soap-added water for 10min QD and then reapply non-adherent dressing | **Instruct patient to soak fingertip in antibacterial soap-added water for 10min QD and then reapply non-adherent dressing | ||
**Follow up with primary care provider in 2d | **Follow up with primary care provider in 2d | ||
**Most will have epithelialization in approximately 1 month<ref>Lamon, RP, et al. Open treatment of fingertip amputations. Ann Emerg Med. 1983; 12(6):358-360.</ref> | **Most will have epithelialization in approximately 1 month<ref name="Lamon">Lamon, RP, et al. Open treatment of fingertip amputations. Ann Emerg Med. 1983; 12(6):358-360.</ref> | ||
===Exposed Bone=== | ===Exposed Bone=== | ||
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**May require distal phalanx amputation | **May require distal phalanx amputation | ||
**Consider treating like Zone II | **Consider treating like Zone II | ||
**Healing time 3-6wks<ref | **Healing time 3-6wks<ref name="Lamon" /> | ||
==Disposition== | |||
==References== | ==References== | ||
Revision as of 05:18, 4 July 2017
Background
- Consult hand surgeon for all patients with Amputation proximal to the lunula (crescent-shaped whitish area)
Anatomy
- The perinychium includes the nail, the nailbed, and the surrounding tissue.
- The paronychia is the lateral nail folds
- The hyponychium is the palmar surface skin distal to the nail.
- The lunula is that white semi-moon shaped proximal portion of the nail.
- The sterile matrix is deep to the nail, adheres to it and is distal to the lunule.
- The germinal portion is proximal to the matrix and is responsible for nail growth.
Clinical Features
Differential Diagnosis
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Evaluation
Fingertip Zones
- Zone I - Distal to tip of phalanx
- Zone II - Between tip of phalanx and lunule
- Zone III - Proximal to lunule
Management
No exposed bone or nail bed involvement
- Zone I injuries - treat conservatively with serial dressing changes alone
- Cover wound with non-adherent dressing
- Instruct patient to soak fingertip in antibacterial soap-added water for 10min QD and then reapply non-adherent dressing
- Follow up with primary care provider in 2d
- Most will have epithelialization in approximately 1 month[1]
Exposed Bone
- Zone II injuries
- Consider hand surgery consult
- Rongeur bone if bony protuberance
- Wound closure with flap
- Follow up with hand surgery in 3-5d
- Healing time 3-6wks
- Zone III injuries
- Consult hand surgery if available
- May require distal phalanx amputation
- Consider treating like Zone II
- Healing time 3-6wks[1]