Fingertip injuries

The family physician often provides the first and only medical intervention for fingertip injuries. Proper diagnosis and management of fingertip injur ies are vital to maintaining proper function of the hand and preventing per manent disability. A subungual hematoma is a painful condition that involve s bleeding beneath the nail, usually after trauma. Treatment requires subun gual decompression, which is achieved by creating small holes in the nail. A nail bed laceration is treated by removing the nail and suturing the inju red nail bed. Closed fractures of the distal phalanx may require reduction but usually are minimally displaced and stable, and can be splinted. Open o r intra-articular fractures of the distal phalanx may warrant referral. Pat ients with mallet finger cannot extend the distal interphalangeal joint bec ause of a disruption of the extensor mechanism. Radiographs help to differe ntiate between tendinous and bony mallet types. Most mallet finger injuries heal with six to eight weeks of splinting, but some require referral. Flex or digitorum profundus avulsion always requires referral. Dislocations of t he distal interphalangeal joint are rare and usually occur dorsally.