Injuries to the nail and finger tip

Finger tip injuries are the most common hand trauma worldwide. They vary from simple lacerations of the tip of the finger to complex phalanx fractures, nail bed lacerations and avulsions, and crush injuries.

Sometimes there is complete amputation of the tip of the finger, and a flap is required to close off the defect.

The aim in management of finger tip injuries is to prevent infection, close the defect/laceration and to provide a sensate and stable tip. Nail bed lacerations need to be managed precisely, in order to prevent permanent nail growth deformity.

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  • Management

Simple lacerations of the tip of the finger, not involving the nail bed may be sutured closed in the emergency department.

All other injuries need surgical intervention.  A thorough cleaning of the injury in a sterile theatre, with appropriate management of the injury/ies is indicated. Nail bed lacerations need to be sutured precisely and nail bed avulsions addressed. This mostly involves removal of the nail in order for the nail bed to be sutured. If there is an underlying fracture this may need to be addressed with either a wire or a screw

If there is a complex injury with tissues that are not viable, these need to be removed and the defect addressed with a flap as necessary.

Conditions Managed

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