injuries poisoning
Fingertip Fractures
Treatment of Fingertip Fractures
Protective covering (eg, finger splint) for 2 weeks For a large or painful subungual hematoma, nail trephination Most fingertip fractures are treated symptomatically with a protective covering (eg, commercially available aluminum and foam splint material) wrapped around the fingertip, often for 2 weeks. Rarely, fractures are displaced enough to require surgical repair. Persistent hyperesthesiamay resolve when treated with desensitization therapy. Subungual hematomascan be drained to relieve pain by puncturing the nail (trephination), usually with an electrocautery device (unless nail polish is present) or an 18-gauge needle in a rotatory, drilling motion; with either method, downward pressure should stop as soon as resistance abates (indicating nail puncture). If trephination is done gently and rapidly, anesthesia is often unnecessary. Otherwise, a digital nerve block (injection of a local anesthetic into the base of the finger) may be used. The nail bed should be repaired with sutures (requiring nail removal) if the nail bed is significantly injured, as long as the wound is not infected and<24 hours old. Repair is not necessary if the laceration is small and held in place by intact nail folds. Previously, nail removal was routinely recommended in patients with a crushed fingertip (with or without an underlying fracture) to evaluate the degree of nail bed injury and determine whether repair was required. However, the nail does not need to be removed if there is no significant injury or deformity to the nail itself. In such cases, nail bed laceration, if present, is likely to heal well on its own when a splint is applied; How To Do Nail Trephination is done as needed to relieve pain caused by a subungual hematoma. If the nail appears severely injured or deformed, the nail should be removed, and the nail bed repaired with thin, absorbable sutures (eg, 6-0 or 7-0 polyglactin). Then the fingertip is wrapped in nonadherent dressing (eg, petrolatum-impregnated bacteriostatic gauze); the wound should be checked within 24 hours to make sure the nail bed does not adhere painfully to the dressing. Evidence suggests that although the injury is technically an open fracture, antibiotics are not needed after nail bed repair in patients with a tuft fracture. 