Right hand dominant middle aged female with history of HTN presents to the ED after accidentally hitting her left index finger with a hammer while working on a home improvement project. Finger is painful and swollen but she has no other injuries and reports she is otherwise feeling well.
Erythematous, swollen, and tender left 2nd distal phalanx. There is a subungual hematoma present over approx. 75% of the nail but the nail is intact. Motor and sensation intact, full ROM of PIP and DIP, 2+ radial pulse, no other injuries identified.
AP, lateral and oblique views of left 2nd phalanx – no fracture or dislocation identified
Nail removal and bedside repair of nail bed laceration, tetanus updated, discharged home with 48 hour follow up for reevaluation
Fingertip injuries = most common hand injuries seen in the ED
Most common mechanisms:
Complications of injury:
Blood Supply and Innervation:
Obtain radiographs to rule out distal phalanx fracture
Evaluate for subunginal hematoma and nail bed lacerations
Drain hematoma if <50% nail involved
Nail removal, I&D, repair of nail bed if >50% of nail involved
CMC ER Residents
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