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