Fingertip Injuries

Subingual haematoma

  • Haematoma under the nail plate
  • If pressure causing pain - trephine
    • Small hole pierced in the thick collagen of the nail plate which allows the haematoma under pressure to drain
    • Pressure and associated pain will disappear instantly
  • Nail may eventually fall off (will grow back)

Nailbed injuries

Categories

  • Type 1 - soft tissue only
  • Type 2 - soft tissue and nail
  • Type 3 - soft tissue and nail and bone
  • Type 4 - proximal 1/3 of phalanx
  • Type 5 - proximal to DIP

Management

  • Keep nail if possible - splint, maintains nail fold
  • Level 1 and 2 - dressing only
  • Level 3 - repair nail bed and stabilise bone
  • Level 4 - repair nail bed and stabilise bone, if there is <5mm of nail bed remaining → ablate
  • If fingertip not avaliable, terminalise the finger or perform a V-Y flap