What injuries happen to fingertips?
The most common cause of fingertip injury is when a door closes suddenly - fingertips, especially those of children, are easily caught in the hinge of a door. Most often, the injury is of the nailbed and possibly underlying bone (see below). Occasionally, the tip of the finger may be lost, although this is more often caused by machinery or power tools.
What is a nailbed injury?
The nail grows from the 'germinal matrix', which is near the white part of the nail at the point where finger skin gives way to nail. The nail grows out, being held to the finger by the underlying nailbed, which is the pink fleshy area seen under the nail. If the fingertip is crushed, for example when trapped by a door, the nailbed can be crushed and split. This needs to be repaired surgically, using very fine stitches. If the nailbed is not repaired then the nail can grow irregularly, or raise off the nailbed as it grows over the previously injured area.
Additionally, the germinal matrix can be repaired if injured. Injury to the germinal matrix can lead to nail growth problems, such as ridges or splits forming as the nail grows. Repair can reduce the risks of this happening.
The surgery can be performed under local anaesthetic, whereby the fingertip is made numb with an injection and you stay awake during the operation. Children will often not tolerate this, though, and so a general anaesthetic is usually given.
What other fingertip injuries can happen?
Machinery or sharp edges can cause loss of the fingertip. An amputated part can, occasionally, be stitched back in place. Often, however, this is not possible. In such cases, treatment may then be with dressings only or a procedure may be required. Procedures vary from simple stitching to skin grafts or flaps (where skin is moved from one part of the finger to another).
Fingers are also prone to tendon injury, which may present as a mallet deformity. The injury may also cause a break or fracture of the finger bone.
How is a broken fingertip bone repaired?
Often, no surgery is needed and a simple broken fingertip can be splinted for about 3 weeks until healed.
Occasionally, if the bone ends are out of place, manipulation of the fingertip may be needed. The finger is made numb with anaesthetic, then the break is manipulated back into a normal position. The fingertip is then splinted, again for about 3 weeks.
In some instances, surgery to the fingertip may be needed. This will usually be either a 'k-wire' or interosseous wire. A k-wire is a thin metal rod that is passed between the broken bones to hold them in place while they heal - this is then easily taken out after 3 weeks. Interosseous wires are thin wires, like fuse wire, that tie the broken bone ends together - these are often left in place permanently.
The treatment your broken fingertip needs will depend on factors such as the type of break, position of break, and other finger injuries - your specialist will be able to discuss best options with you.
What are the long-term risks of fingertip injury?
Pain - scars at fingertips can be tight and painful. This may settle with regular massage to the fingertip or desensitisation therapy by physiotherapy, but can be a long-term problem that is difficult to resolve.
Nail irregularities - despite delicate surgery to repair the fingertip and nail growth parts, problems can still occur. The nail can split or form ridges as it grows, and can lift off the underlying nailbed or turn into the finger as it gets longer. Keeping the nail trimmed short can often help avoid problems, but sometimes further surgery may be needed.
Also read our section on 'What can go wrong with broken fingers' for surgery risks
Other relevant SurgeryWise articles: broken knuckles, broken fingers, fractures, hand surgery, mallet finger
Any procedure involving skin incision can also result in unfavourable scarring, wound infection, or bleeding. This list of risks is not exhaustive, and you should discuss possible complications with your specialist. Whilst these risks will seem very worrysome, and indeed can be serious, it should also be borne in mind that many people have no postoperative problems whatsoever.
The information provided is as a guide only and you should discuss matters fully with your specialist before deciding if this is the right procedure for you. Please also read our disclaimer