Outcome Scores for Fingertip Injuries: A Systematic Review

Most patients recover well following fingertip injuries. Outcomes vary along a spectrum, influenced by both pathophysiological severity and psychosocial factors, which strongly influence patient-reported outcome measures (PROMs). General instruments (e.g., Disabilities of the Arm, Shoulder, and Hand [DASH]; Michigan Hand Questionnaire [MHQ]; and Patient-Reported Outcomes Measurement Information System [PROMIS]) are reliable but often overlook fingertip-specific concerns such as nail deformity, cold intolerance, pulp loss, or subtle sensory changes. To address this gap, the Fingertip Injuries Outcome Score (FIOS) was developed, integrating objective domains (grip strength, range of motion, 2-point discrimination [2PD], and bone union) with patient-reported domains (nail esthetics, sensibility, cold intolerance, pain, and return to work), providing a fingertip-specific assessment. This study systematically reviews outcome scoring systems for fingertip injuries, evaluating their validity, reliability, responsiveness, and clinical utility, with a particular focus on the FIOS-the only instrument specifically designed for fingertip injuries.

A systematic search (PubMed, Scopus, Web of Science; up to December 2024) identified studies evaluating fingertip injuries with defined outcome scores. Data included score domains, psychometrics, and applicability.

FIOS was the only fingertip-specific score identified, demonstrating strong internal consistency (Cronbach α = 0.796) and excellent interrater reliability (κ = 0.844) in its validation study (n = 199), with 93% of patients achieving excellent or good outcomes. An independent pilot (n = 58) confirmed its sensitivity to injury severity. Subgroup analysis showed no significant difference in FIOS outcome distribution across injury mechanisms, though whether this reflects robustness or limited discrimination requires study. General PROMs (MHQ, DASH, Hand20, and PROMIS) each had high internal consistency (α ≥ 0.90) and correlated strongly with psychosocial factors but lacked fingertip-specific coverage. The Hand Injury Severity Score correlated with MHQ but served only as a severity index. By integrating objective and patient-reported domains, FIOS is the most fingertip-specific assessment available.

FIOS is the most complete fingertip-specific outcome instrument and should be adopted as the primary standard for outcome reporting and long-term follow-up across fingertip injuries. For comprehensive assessment, pair FIOS with a general hand/upper-extremity PROM and objective tests (e.g., 2PD, ROM/TAM, and grip strength). Standardizing on FIOS in practice, registries, and trials will harmonize reporting for current and future cohorts and enable clearer comparisons across treatments. While further multicenter validation and responsiveness/minimal clinically important difference estimates remain priorities, the need for a fingertip-specific standard justifies adopting FIOS now with ongoing evaluation.

Therapeutic Level III. Systematic review of cohort and observational studies without randomized controlled trials. See Instructions for Authors for a complete description of levels of evidence.