One of the most common injuries that can occur to a child’s hand is a crush injury to a fingertip. This injury can happen if the finger is slammed in a door, stepped on, or if a large object falls on it.
The fingertip has many important parts (Picture 1) including the skin, nail, and bone.
The nail has two main parts. The nail plate is the part of the nail you trim. The nail bed lies under the nail plate.
There are three bones in your finger. The bone under your nail at the end of your finger is called the “distal phalanx.”
The skin at the tip of your finger (with which you touch things) is called the “pulp.”
A crush injury to the finger can cause many different injuries. These include:
- Fracture of bone
- Nailbed injury
- Fingertip partial amputation
Depending on the type of injury, your child may be prescribed antibiotics. If so, it is very important for him or her to take all of the medicine prescribed. It is also important that the medicine is given at the correct time.
Fracture of Bone
Your child may have a broken finger bone (a fracture) from the force that caused the injury:
- Tuft fracture: the bone closest to the tip of the finger is broken
- Seymour fracture: the break is through the growth plate (see HH-I-412, Seymour Fracture)
Most of the time these fractures can be treated with a simple splint or cast. These keep the bone from moving, usually for 2 to 6 weeks. The medical provider will discuss this with you.
A crushed fingertip will usually be swollen and painful, and may bleed. Bleeding can cause a hematoma (a collection of blood) under the nail. This can be painful. Hematomas under the nail may need to be drained.
Often the nail must be removed for cleaning, evaluation, and potential repair of the nailbed. After the nailbed is repaired, usually:
- the nail is sutured (stitched) back in place, or
- a piece of foil or other synthetic material may be put in the place of the nail.
This is done to make sure the skin near the base of the nail (the eponychium) does not heal over the area from which the nail grows.
The nail may fall off a few weeks after the injury (whether or not it was removed during the injury or initial treatment). It can take many months for the nail to grow back, and the end result may not be known for up to 9 months. It is impossible to know at the time of injury what the nail will eventually look like. Sometimes new nails may have a bend, crease or split; may not fully adhere to the underlying sterile matrix (they may 'lift off' from the underlying skin); or may not fully grow back.
Fingertip Partial Amputation
Some injuries result in part or all of the fingertip being removed (amputated). In children, these fingertip amputations generally heal very well. The fingertip will be cleaned by a medical professional. This will help keep it from getting infected.
- If the wound can be closed, special stitches are used. They are called absorbable sutures. This means they will fall out on their own and will not need to be removed.
- Sometimes the wound involves a large area of the fingertip. If the piece of skin that was cut off is available, it may be stitched over the wound to cover it. Most of the time, this skin will turn black and eventually fall off, but it protects the injured skin underneath very well.
- If a large portion of the fingertip was amputated, a hand specialist may be needed to perform a surgery.
Care of All Fingertip Crush Injuries
Until your follow up appointment:
- Keep all dressings, splints, and casts in place.
- Keep the area clean and dry.
At the appointment, your child’s medical provider will give you instructions about what to do next. You will be told if the dressing can be removed or if it should stay in place. You may be instructed to start “soapy” soaks for the finger.
What to do at Home and What to Expect
It is very important to always follow instructions for care so the area can heal. Your child may need to wear a splint or soak the injury.
Until the doctor says it is ok, your child should:
- not take part in sports (including gym)
- limit lifting, pushing and pulling
- do only low energy activities (no running, no rough play, no jumping)
Expect there to be some pain for 3 to 4 weeks. You may consider giving your child over the counter pain medicine such as Tylenol®. There may be some loss of motion for a while and swelling can continue for weeks. This will get better with time and as your child starts range of motion exercises.
When to Call the Doctor
Call your child’s doctor if there are any of these signs of infection:
- increase in pain
- increase in swelling
- not feeling well
- drainage (fluid coming from the wound)
- fever above 101 degrees Fahrenheit (by mouth)
- fever in combination with other symptoms listed above
Clinic Contact Information:
- Regular clinic hours are Monday through Friday, 8:00 am to 4:30 pm. Phone number is (614) 722-HAND (4263). Ask for the nurse to discuss any symptoms.
- Evenings, weekends and holidays phone (614) 722-2000. Ask for the Hand Resident on call to discuss any symptoms.
HH-I-421 7/16 Copyright 2016, Nationwide Children's Hospital