Injuries to the fingertip are very common accidents that frequently happen at home, the office or at play. They usually occur while engaging in everyday tasks such as chopping vegetables, clearing debris from a lawnmower, slamming a car door or cutting with scissors. Injuries may include damage to the skin and soft tissue, bone or nail resulting from crushing, tearing or amputating injuries to the tips of the fingers.
The finger is made of three bones called phalanges, which run from the fingertip to the knuckle. Starting at the fingertip, they include the distal phalanx, middle phalanx and proximal phalanx. The thumb however has only two phalanges, the distal and proximal phalanx. Additionally, each finger has three joints, the distal inter-phalangeal (DIP) joint between the distal phalanx and middle phalanx, the proximal inter-phalangeal (PIP) joint between the middle phalanx and proximal phalanx and the metacarpo-phalangeal (MP) joint between the head of the meatacarpal and the proximal phalanx. Each finger also encompasses two tendons, the extensor and flexor tendons. Fingertips are rich with nerves, making them very sensitive. Without prompt and proper care, a fingertip injury can disrupt the function of the hand, and may result in permanent damage.
The Orthopaedic Institute’s James B. Slattery, M.D., a board certified orthopaedic surgeon, specializes in hand and upper extremity musculoskeletal injuries, and sees patients with fingertip injuries on a weekly basis.
Trauma to the fingertip and nail are the most common of all hand injuries. Examples of conditions resulting from fingertip injury include hooked nail and subungual hematoma. Hooked nail is a condition that is usually the result of fingertip amputation, with partial or complete loss of the supporting distal phalanx and loss of the distal nail bed and fingertip soft tissue.
“With the loss of the bone needed to support the nail occurs, this causes the nail to grow unevenly following the curvature of the nail bed over the tip of the finger,” Dr. Slattery said.
To learn more about hooked nail, visit
Subungual hematoma occurs when the nail is injured, causing bleeding beneath the nail plate and its subsequent separation from the nail bed. The hematoma puts pressure on the nail bed and causes a throbbing sensation.
The subungual hematoma may slowly enlarge to cause a separation of the nail from the nail bed, resulting in the eventual loss of the finger nail. To prevent the loss of the nail, a small opening in the nail plate over the hematoma allows the blood that is trapped under pressure to be released. To learn more about subungual hematoma, visit http://emedicine.medscape.com/article/1242733-overview#aw2aab6b4.
“A patient should seek medical attention if they experience tingling or loss of feeling in the tip of the finger,” Dr. Slattery said. “The skin affected by the injury may also turn black or blue.”
In the event of a fingertip injury, the American Academy of Orthopaedic Surgeons (AAOS) gives the following tips:
When preparing to see a doctor
- Elevate the injury and apply ice to reduce bleeding and swelling
- Cover the fingertip wound with a dry, sterile dressing
- Immobilize the affected hand and wrist with a short splint
If a fingertip is completely cut off:
- Gently clean the amputated part with water (preferably saline)
- Cover it in gauze wrap
- Put it in a watertight bag
- Place the bag on ice
- Do not put the amputated part directly in ice. You could further damage it.
- Remember to bring the amputated part with you to the emergency room.
Treatment for a fingertip injury includes both non-surgical and surgical options. Your physician will determine if surgical treatment is the best option based on the nature and severity of the injury.