CONSULTANT PLASTIC SURGEON
FINGER INJURIES
What are finger injuries?
Finger injuries are common and range from minor cuts and scrapes to wounds with major damage to bone, tendons, and ligaments. If not treated properly, serious finger injuries can lead to permanent deformity and loss of function. Careful treatment allows for a faster and more complete recovery. Although bleeding, bruising, deformity or swelling of an injured finger may be obvious, significant injuries may be present that are not obvious right away. Some symptoms, such as redness, pus, and fever of infection, will not develop for hours to days.
Many different types of finger injuries are common: a laceration (cut) may only go through the skin, or it may cut through blood vessels, nerves, and tendons that lie just under the skin; an avulsion occurs when part of the skin or soft tissue is torn off, and with an amputation, the tissue is completely cut or torn away from the finger. Finger injuries may include:
Fingernail injuries: the fingernail and the underlying nail bed are the most commonly injured part of the hand. If a fingernail is injured by a direct blow, the underlying bone may also be broken.
Fractures (broken finger bone): each finger (except the thumb) has three bones, or phalanges: the proximal (closest) phalanx (plural-phalanges), the middle phalanx, and the distal (furthest) phalanx. A fracture of a phalanx may be an isolated injury, but it is often associated with injury to tendons, ligaments, fingernails, or other soft tissue.
Dislocation: this is an injury to a joint that causes a bone to move out of its normal alignment with another bone. Finger dislocations commonly happen as a result of a direct blow to the finger (like while playing ball sports). Usually, a dislocation causes damage to the surrounding ligaments (ligaments hold bone to bone), which are stretched and remain damaged even after the dislocation is reduced (put back in place).
Ligament injuries (sprains): ligaments are the tough tissues that hold two bones together and stabilize a joint. A ligament may be torn by a forceful stretch or blow, leaving the joint unstable and prone to further injury.
Tendon injuries: tendons are the fibrous bands that attach muscles to bones and allow the flexible, precise movements of the joints. Tendons lie just under the skin of the fingers and are covered by a protective sheath. Both the tendon and its sheath can be damaged by a laceration (cut) or a crush injury. A tendon can also be torn away from its bony attachment, which is called an avulsion fracture.
Nerve injuries: sensation to the finger is supplied by four nerves, two (dorsal and volar digital nerves) running along each side of the finger. Damaging the nerve can cause numbness on the side of the finger supplied by the nerve.
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What are the common causes of finger injuries?
A finger may be injured by a direct blow or cut. Many injuries are work-related. The finger may also be jammed, twisted, or stretched playing sports. Animal bites are another common cause of finger injuries.
Jammed finger
Several common kinds of injuries that can result from jamming a finger:
Skier's (gamekeeper's) thumb: torn ulnar collateral ligament (the ligament between your thumb and palm in the webspace of the thumb and hand), often caused when a skier falls on his or her pole with an open hand.
Mallet (or drop or hammer) finger: extensor tendon (the tendon that is on the back or "dorsum" of your finger responsible for extending the finger straight) torn away from the distal phalanx (bone at the end of your finger). This causes the tip of your finger to sag and not completely straighten out.
Boutonniere deformity: the stabilizing portion of the extensor tendon (the tendon that is over the backside of your finger) is torn between the proximal and middle phalanges (the closest and middle bones of your finger). This causes an inability to straighten the joint between the proximal and middle phalanges.
Swan neck deformity: volar ligament (ligament on the palm side of your finger responsible for flexing your finger) torn between the proximal and middle phalanges. As this injury heals, the ligament gets lax and the finger bends in a characteristic "swan neck" pattern.
Fingernail injuries
The nail bed, which is the supportive tissue underneath the nail, can be damaged by a cut or blow. Sometimes this leads to a collection of blood under the nail, called a subungual hematoma. Subungual hematomas can be very painful and sometimes need to be drained. If the nail is severely damaged, it may need to be removed.
Bites
Animal bites can cause tissue damage and also can lead to serious infections if not treated properly. A human bite would is often more serious than an animal bite would. It usually happens from punching someone in the mouth with a closed fist (called a "fight bite"). These wounds require thorough cleaning and often antibiotics.
Paronychia
A paronychia is an infection in the area where your fingernail attaches to your finger. It often starts after minor trauma such as a hangnail or nail-biting.
When to seek medical care for finger injuries?
Because the hand is a finely coordinated tool that must function correctly for so many everyday activities, even a relatively minor finger injury can lead to some loss of function. If in doubt, consult Dr Ricardo. Also, contact him if you are not sure whether you have had a tetanus immunization in the last 10 years. Always seek medical care if there is severe pain or deformity, uncontrolled bleeding, numbness (loss of sensation), exposed bones or tendons and if the finger is pale or bluish in colour. Go to a hospital's emergency department if these conditions develop:
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There is heavy bleeding or bleeding that does not stop.
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There is obvious missing tissue or amputation.
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There is an obvious deformity of the finger.
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There is a cut gapes open or goes deeper than the very top layer of skin.
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The patient is unable to completely clean out the dirt or foreign bodies from a wound.
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There is an area of numbness or weakness.
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The patient is unable to use the finger normally.
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The patient develops redness, drainage, pus, swelling, fever, or other signs of infection.
How are finger injuries diagnosed?
Dr Ricardo will want to examine the patient's hand, including testing the strength, sensation, and range of motion of the injured area. If he suspects a fracture or a foreign body such as glass or metal in the wound, X-rays may be ordered. X-rays do not show all types of foreign bodies, nor do they show injuries to tendons or ligaments (such as sprains and strains).
Are there home remedies for finger injuries?
Control bleeding by direct, continuous pressure for at least several minutes. Elevate the hand above the level of the heart to help slow the bleeding. Find torn or missing tissue and save it, if possible.
Gently rinse the tissue off with water if it is very dirty, and place it in a sealed plastic bag. Place the bag in ice water and bring it to the hospital with the patient. Cover the wound with a clean, dry bandage and remove loose dirt or foreign bodies if possible. Do not try to remove objects that are deeply or firmly embedded. Run the patient's hand under tap water for several minutes, scrubbing gently with a washcloth if needed to remove dirt, dry, and then apply an antibacterial ointment.
If the finger is deformed, immobilize it with a splint in whatever position is least painful. Almost any small rigid item such as a popsicle stick, a pen, or a piece of cardboard can be tied or taped to the finger as a splint. A finger can also be buddy-taped-that is, taped to the finger next to it. Tape securely, but not tightly. If the fingers are taped too tightly it can cause additional swelling and may cut off circulation to the injured finger.
How are finger injuries treated?
Treatment for finger injuries depends on the type of injury. Some finger injuries can be treated at home (for example, buddy taping a broken finger). Other more serious injuries to fingers (fractures, dislocations, deep cuts, or wounds) will need medical treatment.
Pain management
Before treating the injury, Dr Ricardo may numb the tissue with a local anaesthetic such as lidocaine. This is usually done by injecting an anaesthetic near the base of the finger, called a "digital block". A digital block is done with a small amount of lidocaine placed on either side of the base of the finger where the main branch of the nerve is located. This provides anaesthesia (numbing) to the entire finger with a minimum amount of needle shots and pain. The patient may also be given pain medications by mouth or through an IV.
Open wounds
If the patient has an open wound such as a laceration or an avulsion, Dr Ricardo may want to explore the wound more carefully to assess the damage or to remove foreign bodies. The wound will then be thoroughly washed. The nail bed, tendons, or other deep structures are sometimes sutured with absorbable (dissolving) thread. Thread used to close the skin usually does not absorb, and stitches will need to be removed in one to two weeks.
Tendon repair
If the patient has an open wound such as a laceration or an avulsion, Dr Ricardo may want to explore the wound more carefully to assess the damage or to remove foreign bodies. The wound will then be thoroughly washed. The nail bed, tendons, or other deep structures are sometimes sutured with absorbable (dissolving) thread. Thread used to close the skin usually does not absorb, and stitches will need to be removed in one to two weeks.
Avulsions and amputations
The separated tissue may be able to be reattached to the finger. Always retrieve the amputated body part (if possible). Cover the amputated body part, keep it damp, and place the part near ice to cool. Do not place the body part in direct contact with ice in order to prevent freezing.
Subungal Hematoma
A large (>50% of nail surface) or very painful patch of blood can be drained from under the nail by "trephination." The procedure is done by boring a few holes in the nail to relieve the pressure and drain the blood. This can be done with a red-hot cautery device (a heated metal probe), a needle twisted through the nail, or a small drill device.
Paronychia
This infection of the lateral nail fold is drained by putting a small incision in the skin overlying the infected area. It is then cleaned, and antibiotics are placed on it. Depending on the severity of the infection, the patient may need oral antibiotics.
Fractures and dislocations
Reduction (realignment) of broken or dislocated bones usually takes place in the emergency department under local anaesthesia. After the bone is put back into place, more X-rays may be performed to make sure the bones are realigned, then a splint is applied. Some fractures and dislocations require surgery to repair.
Splinting
Fractures, dislocations, tendon injuries, and some lacerations may be treated by splinting part of the finger or even the whole hand or wrist. This splinting allows the tissues to rest and therefore heal faster.
Antibiotics
Some wounds are at higher risk of infection than others and may be treated with antibiotics. If the doctor prescribes antibiotics, the patient must take the medication as directed and finish the whole prescription even if the patient feels fine.
How is finger injuries prevention?
The use of appropriate safety equipment during sports and occupational activities could prevent or limit the extent of fractures, dislocations, cuts, and burns. Normal household safety measures, especially with small children, will also decrease the chances of all injuries, including those to the hands. The key to decreasing the long-term effect of a hand injury is timely medical evaluation and treatment.
What is the prognosis for finger injuries?
Prognosis depends on the type and severity of the injury. For certain hand injuries, follow-up and rehabilitation may be the most important factor in the outcome. Follow all postoperative instructions including cleansing, taking prescribed medications, and finger therapy exercises. Therapy is critical to restoring strength, flexibility, and movement. If you attempt to return to normal function too soon, the risk of re-injury is possible. Continue your finger therapy regimen and attend follow-up visits with Dr Ricardo as scheduled. This is essential to a successful outcome.
The outcome of your hand surgery will develop over time. While advances in hand surgery can accomplish near miracles in reconstruction and replantation, your outcome cannot be fully predicted. It may not be realized for several months. If your procedure involved microsurgery, a year is considered appropriate to fully reach restored function.