Fingertip Injuries or Amputations

Tetanus Toxoid Intravenous Antibiotics Mallet Splint Elevation of the Limb

  1. Define the level of amputation and whether it is volar oblique (taking of more pulp) or dorsal oblique (taking of more of the nail).
  2. Nail plate and nail bed loss.
  3. Pulp and volar skin loss.
  4. Bone loss.
  5. Involvement of flexor or extensor tendons.


Initial Management

  1. Tetanus prophylaxis
  2. Treat as open fracture with early initialisation of intravenous prophylactic antibiotics (Cefazolin).
  3. Irrigate wound with saline and wrap up with vaseline gauze and an absorptive material as these wounds can bleed extensively. Wrap the entire digit up from distal to proximal.
  4. Consider a POSI Z-splint as this will immobilise the whole limb for the interim until definitive surgery.


Rehabilitation

  1. The fingertip is protected with a circumferential thermo plastic splint for two to three weeks, until the wound has healed.
  2. Most fingertip injuries are associated with digital nerve injuries and will benefit from desensitisation after wound healing.
  3. Therapy will include scar management and oedema control with pressure garments to shape the tip of the finger and facilitate movement.
  4. Early mobilisation of the finger and especially the distal inter-phalangeal joint is crucial to prevent limitation in range of movement.