40 yo M BIBEMS with no PMH presents with laceration to R index finger. Patient reports he was...
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Transcript of 40 yo M BIBEMS with no PMH presents with laceration to R index finger. Patient reports he was...
40 yo M BIBEMS with no PMH presents with laceration to R index finger. Patient reports he was working on his car when a piece of metal fell and cut off part of his finger.
PMH – deniesPSH – deniesSoc Hx- denies x3Allergies – NKDAMeds – none
Case
Physical Exam –A&Ox3 NADVitals – T98.2 BP136/88 HR 77 RR 16 HEENT – wnlNeck – wnlLungs – CTA blHeart – S1, S2 RRRAbd – Soft NT/ND +BSExtremities – transverse amputation of 1.5cm of R index
finger in zone 2 including nail bed involvement, distal to the germinal matrix, +bone exposure. Decreased ROM at distal interphalangeal joint otherwise FROM in all digits, no sensory deficits no other signs of injury
Case
Vikas Goswamy MS4
SUNY Downstate
Fingertip Injuries
Hand Anatomy
Hand Anatomy
Finger Tip Anatomy
Defined as an injury at or about the level of the lunula
One of the most frequently injured parts of the hand
Can involve skin, soft tissue, nail, nail bed, bone
Fingertip Injuries
Fingertip Injuries
Fingertip InjuriesInvolving only Pulp
Tissue and SkinAmputations that
Involve < 1 cm of finger tip
No bone exposureNo nail or nail bed
involvement Can be treated
conservatively with wound care, education on cleaning, and follow up after 2 days
Fingertip InjuriesWith exposed bone
Management determined by size, geometry, mechanism, and angle of amputation
If <0.5cm but exposed bone, the bone can be trimmed using a rongeur to allow enough space for a soft tissue flap
Close by second intention with wound care after 2 days
For small injuries (<2cm) reattachment is generally not indicated
Fingertip InjuriesNail bed
Made up of the germinal matrix and the sterile matrix
Germinal matrix extends from the nail fold to the lunula
Sterile matrix extends from lunula to hyponychium
Fingertip InjuriesNail bed Involvement
Avulsion injuries to nail bed have poorer prognosis because germinal matrix fragments may be left under nail
If nail is available, use as graft and reattach with 6-0 or 7-0 absorbable mattress stitch
If not available toe nail graft can be used at later time
ReferencesDavenport M. Chapter 41. Injuries to the Arm,
Hand, Fingertip, and Nail. In: Ma OJ, Cline DM, Tintinalli JE, Stapczynski JS, Cydulka RK, Meckler GD, eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York: McGraw-Hill; 2014. http://www.accessemergencymedicine.com/content.aspx?aID=56328606. Accessed October 12, 2012.
AAFP http://www.aafp.org/afp/2001/0801/p455.html
Fingertip Injuries