Related Experiment Videos
[Fingertip injuries in children: 81 cases with at least one year follow-up]
B Salazard1, F Launay, C Desouches
1Service de Chirurgie Plastique, Hôpital Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille 05.
Insights
Pediatric fingertip crush injuries require careful management to prevent long-term issues. Simple emergency room interventions, like nail bed repair and pulp suturing, improve functional and aesthetic outcomes in children.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Emergency Medicine
Context:
- Fingertip crush injuries are common in young children.
- Effective management is crucial to prevent esthetic and functional sequelae.
- Treatment can be challenging in everyday emergency room practice.
Purpose:
- To report experience with simple therapeutic principles for pediatric fingertip injuries.
- To identify factors influencing outcomes in young patients.
- To provide guidance for emergency room management.
Summary:
- A retrospective review of 91 fingertip injuries in 81 children (mean age 4.5 years) was conducted.
- Crush injuries predominated, primarily affecting the middle finger.
- Outcomes assessed included sensitivity, pulp and nail appearance, and parental satisfaction after at least one year.
Impact:
- Most children (80%) had very good outcomes according to parents.
- Complications included infections (4%) and necrosis (2%).
- Sensory disorders (8%) and nail dystrophy (25%) were observed, with nail bed injury correlating with sensitivity issues and pulp amputation with nail dystrophy.
Purpose Of The Study:
Fingertip crush injuries are frequent in young children. Rigorous care is required to avoid esthetic and functional sequelae, but treatment is often difficult. We report our experience focusing on simple therapeutic principles useful for everyday practice in the emergency room.
Material And Methods:
We reviewed retrospectively 91 fingertip injuries in 81 children followed for at least one year. Mean age of the children was 4.5 years. Crush injuries predominated (82%) and mainly involved the middle finger. We recorded the initial lesions, therapeutic interventions, and early complications. At last follow-up, we recorded sensitivity, aspect of the pulp and nail, and the subjective assessment of the parents.
Results:
There were four infectious including three periungual and subungual felons and two necrotic complications. One child developed a bone infection that required surgery and antibiotics. At last follow-up, seven patients (8%) had sensorial disorders, six (7%) an inesthetic pulp and 23 (25%) dystrophic nails (minor=19, major=4). The parents felt the result was very good for 80% of the children,. Pulp sensitivity disorders were more frequent when the nail bed was injured. Nail dystrophy was more frequent after initial pulp amputation.
Discussion:
The nail plays an important role in finger function, increasing tactile sensitivity and facilitating prehension. Fingertip injuries can be considered benign but require careful initial evaluation and rigorous management. If a sub-ungual hematoma covers more than half of an intact nail, puncture with a cold lancet appears to be indicated to avoid infection and reduce pain. Perforation with a heated instrument (paper clip) is easy to perform but the hematoma may reform rapidly. In the event of fracture, perforation should always be performed. Detached nails should be removed to examine the nail bed which must be sutured carefully if injured. Pulp lesions should also be sutured.