Middle age male with no significant PMH presents to the ED after amputating his right index distal fingertip.
Physical Examination: Patient has a right transverse (slightly volar oblique) index fingertip amputation with distal tuft visible within the wound. The laceration grazed the nailbed. Sensation is intact in the radial/medial/ulnar distributions of the hand including throughout the index finger. Radial pulse is palpable and the finger has good capillary refill.
XR of right hand is notable for distal tuft amputation but negative for foreign body.
Approximately 1mm of the nail plate was removed exposing the edge of the nailbed. Soft tissues, including the fat volarly and the nailbed dorsally were elevated off of the distal phalanx. Distal phalanx was then rongeured until sufficient soft tissue could be mobilized to cover the bone. The soft tissue was then sutured close. The wound was covered with Xeroform and dressed. Ancef was given prior to discharge. Orthopedic follow up was arranged for the following day.
CMC ER Residents
Disclaimer: All images and x-rays included on this blog are the sole property of CMC EM Residency and cannot be used or reproduced without written permission. Patient identifiers have been redacted/changed or patient consent has been obtained. Information contained in this blog is the opinion of the author and application of material contained in this blog is at the discretion of the practitioner to verify for accuracy.