Citation

Weichman KE, Wilson SC, Samra F, Reavey P, Sharma S, Haddock NT. Plast. Reconstr. Surg. 2013; 131(1): 107-112.

Affiliation

1New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery, New York, NY 2Univeristy of Pennsylvania Hospital, Philadelphia, PA.

Copyright

(Copyright © 2013, Lippincott Williams and Wilkins)

DOI

10.1097/PRS.0b013e3182729ec2

PMID

22965236

Abstract

BACKGROUND:: Fingertip injuries are the most common hand injuries presenting for acute care. Treatment algorithms have been described based on defect size, bone exposure, and injury geometry. However, most of the outcomes data is associated with specific procedures and there is a dearth of comparative data across injury type. We hypothesized that despite accepted algorithms many fingertip injuries can be treated conservatively. METHODS:: A prospectively collected retrospective review of all fingertip injuries presenting to Bellevue Hospital between January 2011 and May 2011 was conducted. Patients were entered into an electronic database upon presentation. Follow-up care was tracked through the electronic medical record. Patients lost to follow-up were questioned via telephone. Patients were analyzed based on age, mechanism of injury, handedness, occupation, wound geometry, defect size, bone exposure, emergency room procedures performed, need for surgical intervention, and outcome. RESULTS:: 100 fingertips were injured. Injuries occurred by crush(46%), laceration(30%), and avulsion(24%). 64% of patients healed without surgery, 18% required operative intervention, and 18% were lost to follow up. Patients requiring operative intervention were more likely to have a larger defect, 3.28cm vs. 1.75 cm(p<0.005), volar oblique injury, 50% vs. 8.8%(p<0.005), exposed bone, 81.3% vs. 35.3%(p<0.005) and an associated distal phalanx fracture, 81.3% vs. 47.1%(p<0.05). Patients requiring surgical intervention had a longer average return to work time when compared to those not requiring surgical intervention, 4.33 vs. 2.98 weeks(p<0.001). CONCLUSION:: Despite current accepted algorithms, many fingertip injuries can be treated non-operatively to achieve optimal sensation, fine motor, and earlier return to work. LEVEL OF EVIDENCE:: Therapeutic Level 3.

Language: en