Fingertip Injuries: A Review and Update on Management

Fingertip injuries are among the most common injuries seen in the emergency department. Specific considerations in management include ensuring robust soft-tissue coverage over exposed bone or tendon, maximizing functional length, preserving nail function and appearance, and minimizing chronic pain. Bony injuries are generally managed non-operatively, although select operative indications exist-particularly for jersey finger injuries, unstable fractures, or those with significant translation. Nail bed injuries can be managed with trephination for subungual hematomas or formal nail plate removal with nail bed repair depending on the degree of nail plate or soft-tissue injury. Soft-tissue coverage can be approached in a stepwise manner with secondary intention, grafts, or flaps from the affected digit, adjacent digits, or hand all playing a role. With proper management, most patients can achieve good outcomes.