orthocare

Dupuytren’s Contracture

Find out more about Flexor Tendon Injuries

Injuries to the fingertip can involve crushing, tearing, or amputation (cutting-off) of the tips of the fingers, which can occur at home, work or during play. Fingertip injuries can occur during every-day activities while using a knife, a lawnmower or snow blower, or when we jam our hands/fingers in the door. They are the most common injuries that occur to the hand. The tips of the longer fingers are more prone to such injuries. The skin, soft tissue, bone, nail and/or nail bed can become damaged with these types of injuries.

First aid
First aid can be administered immediately after the injury before visiting a doctor. You should clean the injured part, elevate it and apply ice to reduce the bleeding and swelling. Cover the fingertip with a sterile dressing and immobilize it with the help of a splint. For a fingertip that has been amputated, you should clean the amputated part with saline and wrap it in gauze. The injured part can be inserted in a watertight bag and the bag can be placed on ice. Avoid putting the amputated part directly in ice as it can damage it further.

Diagnosis
At the doctor’s office, your doctor will ask you how the injury happened, and consider your medical history. The wound will be examined for missing tissue, exposed bone, and nail injury. Your doctor will clean the wound to remove contaminants and dead tissue, and will inject an anesthetic to relieve pain in the affected finger. X-rays may be ordered to confirm fractures.

Treatment
The fingertips have a rich nerve supply and are very sensitive. If not treated immediately and efficiently, the injury can lead to permanent deformity and can disrupt the complex functioning of the hand. The aim of treatment is to alleviate pain, and preserve sensation and normal functioning of the hand and fingers.

Your doctor may pierce the finger to relieve pressure if blood builds up under the nail. You may be given antibiotics or tetanus shot to prevent infection. Treatment of fingertip injury depends on the extent of injury and the angle of cut.

Tissue injury without exposed bone
A small wound may close on its own. Your doctor may cover it with a dressing and recommend a splint for protection while the wound heals. You may be instructed to soak the finger in warm water and an antiseptic solution.

Large and open fingertip wounds that do not have any skin remaining to cover the wound may require surgery. Surgery involves covering the injury with a skin graft taken from your palm (donor site), and suturing both the openings.

Exposed bone injury
A large injury with exposed bone may not have enough tissue to cover the wound, and would require surgery. Surgical techniques include:

  • Reconstructive flap surgery: This surgery is performed to cover the wound with new skin, fat and blood vessels. Skin flap or soft tissues can be taken from the injured or healthy finger, or palm of the same hand. The flap can also be taken from skin next to the wound and pulled over the injured finger to cover it while it is still connected to the donor site. This provides a healthy blood supply to the injured tissue. Once the wound is covered with the skin graft, it is allowed to heal.
  • Replantation: If a large part of the fingertip is cut-off, your surgeon may reattach the amputated part to the wound site.

Fingertip injuries in children
The surgeon will clean and prepare your child’s amputated fingertip and reattach it. Even in case of injury with bone exposure, the reattached fingertip should continue to grow normally. This is especially possible in children below 2 years of age.

Physical therapy
Exercise may be suggested for improving the strength and movement of your hands. Your doctor or physical therapist may suggest additional therapies such as electric stimulation of the nerves, heat and massage therapy, traction, splinting, and special wrappings to control swelling and promote healing.

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