Fingertip (Tuft) Fractures

CHAPTER 111


Fingertip (Tuft) Fractures


Presentation


The patient seeks help after a crushing injury to the fingertip, such as catching it in a closing car door. The finger tip will be swollen and painful, with ecchymosis. There may or may not be a subungual hematoma, open nail bed injury, or fingerpad laceration.


What To Do:


image Assess for associated injuries and distal interphalangeal (DIP) joint instability.


image Obtain finger radiographs with anteroposterior and lateral views.


image If there are open wounds, perform a digital block (see Appendix B), thoroughly cleanse and débride any open wounds, and repair any nail bed lacerations (see Chapter 146).


image For open-tuft fractures with clean wounds, prophylactic antibiotic coverage is not indicated. Early aggressive local wound care has been found to be the best prevention against infection in open fingertip fractures. When there is gross contamination with marginally viable tissue, prophylactic antibiotics such as cefazolin (Ancef), 1000 mg IV, followed by cephalexin (Keflex), 500 mg qid PO × 5 days, may be appropriate.


image Provide tetanus prophylaxis for open fractures (see Appendix H).


image Treat painful subungual hematomas (see Chapter 156).


image Apply a sterile, nonadhesive protective dressing to open wounds (see Appendix C), and with or without an open wound, provide an aluminum fingertip splint (Figure 111-1) to prevent further injury and pain.


image


Figure 111-1 Aluminum fingertip splint.


image If necessary, provide oral analgesics and advise the patient to elevate the injury above the heart to minimize swelling.


image Ensure follow-up to monitor the patient’s recovery, and in the case of open fracture, to intervene in the event of infection.


What Not To Do:


image Do not splint the proximal interphalangeal joint.


image Do not prescribe prophylactic antibiotics for clean and uncomplicated open fractures of the distal tuft. Prophylactic antibiotics have been shown to be of no benefit when aggressive irrigation and débridement have been provided.


image Do not obtain cultures from acute open-tuft fractures. They have not been shown to be helpful in making therapeutic decisions.


Aug 11, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Fingertip (Tuft) Fractures
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