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Treatment and Outcomes of Fingertip Injuries at a Large Metropolitan Public Hospital
Nicholas T. Haddock, MD1; Katie E. Weichman, MD2; Stelios C. Wilson1; Feras Samra1; Patrick L. Reavey, MD, MS1; Sheel Sharma, MD1; (1)New York University Langone Medical Center, (2)New York University
New York University Langone Medical Center, New York, NY, USA

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 who were 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. 67.8% of patients were men and 32.2 % were female. The majority of patients were right handed (75%) and injuries occurred in nearly equally to the right and left hands (52% vs 48% respectively). Injuries occurred by crush(46%), laceration(30%), and avulsion(24%). The average defect size was 1.87cm2. 64% of patients healed without surgery, 18% required operative intervention, and 18% were lost to follow up. Operative interventions included nail bed ablation(3%), full thickness skin graft(3%), bone fixation(2%), cross finger flap(2%), completion amputation(2%), atasoy flap(1%), thenar flap(1%), and tendon reconstruction(1%). Patients requiring operative intervention were more likely to have a larger soft tissue defect 3.28cm2 vs. 1.75 cm2(p <0.005) and volar oblique injury 50% vs. 8.8%.(P <0.005) They were additionally more likely to have exposed bone, 81.3% (n=13) versus 35.3% (n=24) (p=0.0009) and an associated distal phalanx fracture, 81.3% (n=13) versus 47.1% (n=32) (p=0.013). Patients requiring surgical intervention had a longer average return to work time when compared to those not requiring surgical intervention 4.33 versus 2.98 weeks (p=0.0096) respectively.

Conclusion:

Despite current accepted algorithms, many fingertip injuries can be treated non-operatively to achieve optimal sensation, fine motor, and earlier return to work.


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