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Treatment and Outcomes of Fingertip Injuries at a Large Metropolitan Public Hospital

Weichman, Katie E. M.D.; Wilson, Stelios C. B.S.; Samra, Fares M.D.; Reavey, Patrick M.D.; Sharma, Sheel M.D.; Haddock, Nicholas T. M.D.

Plastic and Reconstructive Surgery: January 2013 - Volume 131 - Issue 1 - p 107–112
doi: 10.1097/PRS.0b013e3182729ec2
Hand/Peripheral Nerve: Original Articles

Background: Fingertip injuries are the most common hand injuries presenting for acute care. Treatment algorithms have been described based on defect size, bone exposure, and injury geometry. The authors hypothesized that despite accepted algorithms, many fingertip injuries can be treated conservatively.

Methods: A prospectively collected retrospective review of all fingertip injuries presenting to Bellevue Hospital between January and May of 2011 was conducted. Patients were entered into an electronic database on presentation. Follow-up care was tracked through the electronic medical record. Patients lost to follow-up were questioned by means of telephone. Patients were analyzed based on age, mechanism of injury, handedness, occupation, wound geometry, defect size, bone exposure, emergency room procedures performed, need for surgical intervention, and outcome.

Results: One hundred fingertips were injured. Injuries occurred by crush (46 percent), laceration (30 percent), and avulsion (24 percent). Sixty-four percent of patients healed without surgery, 18 percent required operative intervention, and 18 percent were lost to follow-up. Patients requiring operative intervention were more likely to have a larger defect (3.28 cm2 versus 1.75 cm2, p < 0.005), volar oblique injury (50 percent versus 8.8 percent, p < 0.005), exposed bone (81.3 percent versus 35.3 percent, p < 0.005), and an associated distal phalanx fracture (81.3 percent versus 47.1 percent, p < 0.05). Patients requiring surgical intervention had a longer average return to work time when compared with those not requiring surgical intervention (4.33 weeks versus 2.98 weeks, p < 0.001).

Conclusion: Despite current accepted algorithms, many fingertip injuries can be treated nonoperatively to achieve optimal sensation, fine motor control, and earlier return to work.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

New York, N.Y.; and Philadelphia, Pa.

From the New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery; and the University of Pennsylvania Hospital.

Received for publication April 6, 2012; accepted July 30, 2012.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Nicholas T. Haddock, M.D.; Department of Plastic Surgery, University of Texas Southwestern, 1801 Inwood Road, Dallas, Texas 75390, haddockmd@gmail.com

©2013American Society of Plastic Surgeons