Pediatric emergency medicine trisk 3338 3338
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CLINICAL PEARLS AND PITFALLS
Digital block of the affected finger will likely be more successful than
attempts at local anesthesia.
Avulsed fingertips may be able to be reimplanted and should be
protected in a saline-moistened gauze in a bag that is kept cool in an
ice–water mixture.
Absorbable sutures are equally effective in fingertip wound repair and
require less trauma for removal.
Trephination for an acute subungual hematoma is generally indicated
when it involves more than 50% of the nail bed surface.
Clinical Considerations
Clinical Recognition
Fingertip injuries are very common, as the tips of the fingers are often the entry
point to exploration of our surroundings. Crush injuries are the most frequent
cause and can result in injuries ranging from minor lacerations and subungual
hematomas to complex open fractures and tissue loss. Beyond crush injuries,
lacerations are also common. While some injuries are superficial and
straightforward, more severe injuries such as complete fingertip amputations can
occur, particularly if the mechanism also has the force to damage the nail.
Although children often recover quite well, careful attention and care to these
wounds can help reduce the risk of permanent deformity to the fingertip and nail.
Initial Assessment
Adequate inspection of the injured fingertip is crucial in determining
management. Fingertip injuries are often associated with significant pain and
bleeding that may impede a provider’s assessment and repair efforts. Performing
a digital block of the affected digit will likely be required for adequate pain
control, after a careful examination of fingertip sensation to evaluate for digital
nerve injury. Consultation with a hand specialist is indicated if there is injury to
the digital nerve. Bleeding is a common feature of fingertip injuries, especially
once the tissue is manipulated, and an easily removable tourniquet device is
recommended to achieve hemostasis and facilitate adequate examination and
repair. Timely removal of the tourniquet at the conclusion of the procedure is
essential.
