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Case

Case. 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 – denies PSH – denies Soc Hx - denies x3 Allergies – NKDA Meds – none. Case. Physical Exam – A&Ox3 NAD

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Case

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  1. Case • 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 – denies • PSH – denies • SocHx- denies x3 • Allergies – NKDA • Meds – none

  2. Case • Physical Exam – • A&Ox3 NAD • Vitals – T98.2 BP136/88 HR 77 RR 16 • HEENT – wnl • Neck – wnl • Lungs – CTA bl • Heart – S1, S2 RRR • Abd – Soft NT/ND +BS • Extremities – 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

  3. Fingertip Injuries VikasGoswamy MS4 SUNY Downstate

  4. Hand Anatomy

  5. Hand Anatomy

  6. Finger Tip Anatomy

  7. Fingertip Injuries • 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

  8. Fingertip Injuries

  9. Fingertip Injuries • Involving only Pulp Tissue and Skin • Amputations that Involve < 1 cm of finger tip • No bone exposure • No nail or nail bed involvement • Can be treated conservatively with wound care, education on cleaning, and follow up after 2 days

  10. Fingertip Injuries • With 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

  11. Fingertip Injuries • Nail 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

  12. Fingertip Injuries • Nail 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

  13. Fingertip Injuries • References • Davenport 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

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