Volume 7 | Issue 3 | September-December 2021 | Page: —– | Parag Lad, Sanket Tanpure
Authors: Parag Lad , Sanket Tanpure 
 Department of Orthopaedic, Jupiter Lifeline Hospital, Thane, Maharashtra, India.
Address of Correspondence
Dr. Sanket Tanpure,
Department of Orthopaedic, Jupiter Lifeline Hospital, Thane, Maharashtra, India.
Introduction: The fingertip is the most commonly injured part of the hand; therefore, fingertip injuries are among the most frequent injuries that surgeons are required to treat. Crush injuries of the fingertip are typically due to compression by a closing door. We report a late presentation of fingertip crush injury and its management on the dominant little finger in a child.
Case presentation: A 2-year-old male presented with infected and early necrosis of dominant hand little fingertip, caused due to door crush injury. The patient presented at 35 days with an exposed distal phalanx, marginal necrosis and partially healed, ulnarly-placed pulp of the fingertip. The parents of the child were counselled for one attempt of thorough debridement and consideration of pulp adipo-fascial flap repositioning to cover the distal phalanx. Local debridement and trimming of the pulp skin edges were carried out. The ulnarly displaced pulp was repositioned on the tip to cover the distal phalanx and sutured to the radial aspect of the nail fold with absorbable sutures. At 2 years follow up, the injured little finger was normal in cosmesis, function and nail growth.
Conclusion: Healing potential in children is good. Thorough debridement, nailbed and pulp reconstruction to cover the tip of distal phalanx and immobilisation for two weeks help to provide better cosmesis in the form of normal contour of the fingertip and movements, even in late presenting cases.
Keywords: Childhood crush injury, Fingertip, Late presentation, Debridement
1. Glicenstein J. and Haddad R. Management of fingertip injury in the child. In: Foucher G. (ed.), Fingertip and Nailbed Injuries. Churchill Livingstone, 1991: pp. 120-128.
2. Doraiswamy NV, Baig H. Isolated Finger injuries in chil¬dren-incidence and aetiology. Injury. 2000;31(8):571-3.
3. Fetter-Zarzeka A, Joseph MM. Hand and fingertip injuries in children. Pediatr Emerg Care. 2002;18(5):341-5.
4. Ljungberg E, Rosberg HE, Dahlin LB. Hand injuries in young children. J Hand Surg Br. 2003;28(4):376-80.
5. Fetter-Zarzeka A, Joseph MM. Hand and fingertip injuries in children. Pediatr Emerg Care. 2002;18(5):341 345.
6. Patel L. Management of simple nail bed lacerations and subungual hematomas in the emergency department. Pediatr Emerg Care. 2014;30(10):742-745.
7. Van Beek AL, Kassan MA, Adson MH, Dale V. Management of acute fingernail injuries. Hand clinics. 1990 Feb 1;6(1):23-35.
8. Kubus M, Andrzejewska E, Kuzanski W. Fingertip injuries in children treated in Department of Pediatric Surgery and Oncology in the years 2008-2010 [abstract only]. Ortop Traumatol Rehabil. 2011;13(6):547-554.
9. Innis PC. Office evaluation and treatment of finger and hand injuries in children. Curr Opin Pediatr. 1995;7(1):83-87.
10. de Alwis W. Fingertip injuries. Emerg Med Australas. 2006;18(3):229-237.
11. Macgregor DM, Hiscrox JA. Fingertip trauma in children from doors. Scot Med J. 1999;44(4):114-115.
12. Yorlets RR, Busa K, Eberlin KR, Raisolsadat MA, Bae DS, Waters PM, Labow BI, Taghinia AH. Fingertip injuries in children: epidemiology, financial burden, and implications for prevention. Hand. 2017 Jul;12(4):3427.
13. Giddins GE, Hill RA. Late diagnosis and treatment of crush injuries of the fingertip in children. Injury. 1998 Jul 1;29(6):447-50.
14. Karakas AO, Yuce E. Evaluation of pediatric fingertip injuries using etiology, demographics and therapy. The Medical Bulletin of Sisli Etfal Hospital. 2020;54(3):306.
|How to Cite this Article: Tanpure S, Lad P | Late Presentation and Reconstruction of Fingertip Crush Injury in a Child: A Unique Case Report | International Journal of Paediatric Orthopaedics | September-December 2021; 7(3): —–.|