Pediatric emergency medicine trisk 3402 3402

Fingertip injuries should be evaluated for an associated nail bed injury and for possible fractures of the phalanges Under years of age, conservative management of simpler injuries without repair will often yield excellent results Not recognizing open fractures, injuries involving the distal interphalangeal joint space or injuries associated with tendon lacerations can lead to serious complications Attempting to drain subungual hematoma after 48 hours is unlikely to be effective Fingertip Avulsion Fingertip injuries are rather common in children In the young child, most of these injuries are blunt and secondary to entrapment of the finger in closing doors Most of these injuries are contused lacerations or partial avulsions Complete amputation of the fingertips is less common Sharp injuries such as with knives or equipment are more common in the older child and less likely to be associated with fractures Fingertip injuries should be evaluated clinically for an associated nail bed injury and radiographically for possible fractures of the phalanges In general, this type of injury is managed by the emergency provider, especially in the preadolescent child, because tissue regeneration is remarkable and management is mostly conservative Lacerations can be repaired using absorbable chromic gut The management of amputations of fingertips (distal to the distal interphalangeal joint) can be approached based on the absence or presence of bone exposure If no or minimal bone is exposed, conservative management is advised In children under years of age, complete distal tip spontaneous regeneration is possible even without a surgical repair The wound should be cleansed, dressed in nonadherent gauze, and splinted for protection When tissue from the distal tip is available and has retained its morphology, it can be tacked on to serve as a nonsurviving biologic dressing while underlying tissue develops Frequent dressing changes and appropriate follow-up should be planned Antibiotic coverage is recommended When a significant amount of bone is exposed, consultation with a hand specialist should be considered Shortening of the distal phalanx and covering the tip with volar skin flap is usually the treatment of choice However, some hand specialists advocate for various skin-grafting procedures to avoid permanent shortening and deformity Consider microscopic