Purpose of the study: Fingertip crush injuries are frequent in young children. Rigorous care is required to avoid esthetic and functional sequelae, but treatment is often difficult. We report our experience focusing on simple therapeutic principles useful for everyday practice in the emergency room.
Material and methods: We reviewed retrospectively 91 fingertip injuries in 81 children followed for at least one year. Mean age of the children was 4.5 years. Crush injuries predominated (82%) and mainly involved the middle finger. We recorded the initial lesions, therapeutic interventions, and early complications. At last follow-up, we recorded sensitivity, aspect of the pulp and nail, and the subjective assessment of the parents.
Results: There were four infectious including three periungual and subungual felons and two necrotic complications. One child developed a bone infection that required surgery and antibiotics. At last follow-up, seven patients (8%) had sensorial disorders, six (7%) an inesthetic pulp and 23 (25%) dystrophic nails (minor=19, major=4). The parents felt the result was very good for 80% of the children,. Pulp sensitivity disorders were more frequent when the nail bed was injured. Nail dystrophy was more frequent after initial pulp amputation.
Discussion: The nail plays an important role in finger function, increasing tactile sensitivity and facilitating prehension. Fingertip injuries can be considered benign but require careful initial evaluation and rigorous management. If a sub-ungual hematoma covers more than half of an intact nail, puncture with a cold lancet appears to be indicated to avoid infection and reduce pain. Perforation with a heated instrument (paper clip) is easy to perform but the hematoma may reform rapidly. In the event of fracture, perforation should always be performed. Detached nails should be removed to examine the nail bed which must be sutured carefully if injured. Pulp lesions should also be sutured.