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Management of Pediatric Distal Fingertip Injuries: A Systematic Literature Review
Ashwin Venkatesh1, Ankur Khajuria2,3, Aina Greig3
1School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Insights
Pediatric fingertip injuries require careful management to restore function and appearance. Current treatment strategies lack robust evidence, highlighting the need for further research in pediatric hand surgery.
Area of Science:
- Pediatric Hand Surgery
- Traumatology
- Nail Bed Injuries
Background:
- Nail bed and fingertip injuries are frequent in children, potentially causing significant functional and cosmetic deficits.
- These injuries encompass a range of presentations, including subungual hematomas, lacerations, crush injuries, avulsions, and amputations, often with associated fractures.
- Optimal management aims to restore a painless and functional fingertip, but clinical practice varies due to management controversies.
Purpose of the Study:
- To review the current evidence base for managing nail bed and fingertip injuries in children.
- To identify gaps in knowledge and areas requiring further investigation.
Main Methods:
- A systematic literature search was conducted on the PubMed database.
- The search covered studies published from March 2001 to March 2019.
- Included studies focused on pediatric patients (<18 years) with fingertip injuries (distal to the distal interphalangeal joint).
Main Results:
- The evidence supporting various clinical management strategies for pediatric fingertip injuries is limited.
- A significant lack of high-quality (Level I) data was identified.
Conclusions:
- The current evidence base for pediatric fingertip injury management is insufficient.
- Further high-quality research, particularly randomized controlled trials, is essential to guide clinical practice and improve patient outcomes.
Abstract:
Nail bed and fingertip injuries are the commonest hand injuries in children and can lead to profound functional and cosmetic impairments if not appropriately managed. Fingertip injuries can present with subungual hematomas, simple or stellate lacerations, crush, or avulsion injuries, often with associated fractures or tip amputations. The fundamentals of managing nail bed injuries concern restoring the form and function of a painless fingertip. However, there are controversies surrounding the optimal management of each of these injuries, which has led to nonuniformity of clinical practice.
Methods:
The PubMed database was searched from March 2001 to March 2019, using a combination of MeSH terms and keywords. Studies evaluating children (<18 years of age) and the fingertip (defined as distal to the distal interphalangeal joint) were included following screening by the authors.
Results And Conclusion:
The evidence base for the diverse clinical management strategies currently employed for fingertip injuries in the pediatric population is limited. Further studies yielding level I data in this field are warranted.
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Assessment:
1. Clinical Evaluation:
History: