Management of Pediatric Distal Fingertip Injuries: A Systematic Literature Review

Abstract

Nail bed and fingertip injuries are the commonest hand injuries in children and can lead to profound functional and cosmetic impairments if not appropriately managed. Fingertip injuries can present with subungual hematomas, simple or stellate lacerations, crush, or avulsion injuries, often with associated fractures or tip amputations. The fundamentals of managing nail bed injuries concern restoring the form and function of a painless fingertip. However, there are controversies surrounding the optimal management of each of these injuries, which has led to nonuniformity of clinical practice.

Methods: The PubMed database was searched from March 2001 to March 2019, using a combination of MeSH terms and keywords. Studies evaluating children (<18 years of age) and the fingertip (defined as distal to the distal interphalangeal joint) were included following screening by the authors.

Results and conclusion: The evidence base for the diverse clinical management strategies currently employed for fingertip injuries in the pediatric population is limited. Further studies yielding level I data in this field are warranted.

Fig. 1.

Schematic of the different presentations of distal tip injuries, demonstrating simple laceration, stellate laceration, crush injury, avulsion injury, and subungual haematoma (with associated lateral view).

Fig. 2.

PRISMA diagram and search strategy used:“Infant”[Mesh] OR “Child”[Mesh] OR “Adolescent”[Mesh] AND “Nails/injuries”[Mesh] OR “Nails/surgery”[Mesh] OR “Finger Injuries”[Mesh] OR “Nail Diseases/surgery”[Mesh] OR “Nail Diseases/therapy”[Mesh]

Fig. 3.

Schematic of the nail apparatus.

Fig. 4.

Schematic of a Seymour fracture. Since the extensor tendon inserts into the epiphysis, which is proximal to the insertion of the flexor digitorum profundus (FDP), fractures at the metaphysis cause net extension of the proximal fragment (up arrow) and unopposed flexion of the distal fragment of the distal phalanx (down arrow).