Fingertip avulsion: Difference between revisions
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*Consult hand surgeon for all patients with [[Amputation]] proximal to the lunula (crescent-shaped whitish area) | *Consult hand surgeon for all patients with [[Amputation]] proximal to the lunula (crescent-shaped whitish area) | ||
==Anatomy== | ===Anatomy=== | ||
* The '''perinychium''' includes the nail, the nailbed, and the surrounding tissue. | * The '''perinychium''' includes the nail, the nailbed, and the surrounding tissue. | ||
* The '''paronychia''' is the lateral nail folds | * The '''paronychia''' is the lateral nail folds | ||
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*The '''sterile matrix''' is deep to the nail, adheres to it and is distal to the lunule. | *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. | *The '''germinal''' portion is proximal to the matrix and is responsible for nail growth. | ||
==Clinical Features== | |||
==Differential Diagnosis== | |||
==Diagnosis-- | |||
===Fingertip Zones=== | ===Fingertip Zones=== | ||
*Zone I - Distal to tip of phalanx | *Zone I - Distal to tip of phalanx | ||
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==Management== | ==Management== | ||
===No exposed bone or nail bed involvement=== | ===No exposed bone or nail bed involvement=== | ||
*Zone I injuries - | *Zone I injuries - treat conservatively with serial dressing changes alone | ||
**Cover wound with non-adherent dressing | **Cover wound with non-adherent dressing | ||
**Instruct pt to soak fingertip in antibacterial soap-added water for 10min QD and then | **Instruct pt to soak fingertip in antibacterial soap-added water for 10min QD and then reapply non-adherent dressing | ||
**F/u with PCP in 2d | **F/u with PCP in 2d | ||
**Most will have epithelialization in approx 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 approx 1 month<ref>Lamon, RP, et al. Open treatment of fingertip amputations. Ann Emerg Med. 1983; 12(6):358-360.</ref> | ||
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**Healing time 3-6wks | **Healing time 3-6wks | ||
*Zone III injuries | *Zone III injuries | ||
**Consult hand | **Consult hand surgery if available | ||
**May require distal phalanx | **May require distal phalanx amputation | ||
**Consider treating like Zone II | **Consider treating like Zone II | ||
**Healing time 3-6wks<ref>Lamon, RP, et al. Open treatment of fingertip amputations. Ann Emerg Med. 1983; 12(6):358-360.</ref> | **Healing time 3-6wks<ref>Lamon, RP, et al. Open treatment of fingertip amputations. Ann Emerg Med. 1983; 12(6):358-360.</ref> | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 06:40, 1 June 2015
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
==Diagnosis--
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 pt to soak fingertip in antibacterial soap-added water for 10min QD and then reapply non-adherent dressing
- F/u with PCP in 2d
- Most will have epithelialization in approx 1 month[1]
Exposed Bone
- Zone II injuries
- Consider hand surg consult
- Rongeur bone if bony protuberance
- Wound closure with flap
- F/u 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[2]