Crush Injuries of the Fingers
Crush injuries to a fingertip or toe tip are frequently seen in children. Such injuries may occur when a finger gets caught in a door, stepped on, or struck by a heavy object with significant force. These injuries can affect the:
- Skin – a cut, scrape, blood blister, or a bruise.
- Nail – bleeding or a blood clot under the nail, a cut where the nail grows (nail bed), bleeding around the cuticle, or a cut or tear in the nail (nail laceration).
- Bone – a break (fracture) at the end of a bone where it grows (the growth plate) (Picture 1).
- Tip of the finger or toe – the tip gets cut off (partial amputation).
Most minor injuries such as cuts, scrapes, blood blisters under the skin, and bruises naturally heal by themselves. However, if an injury appears severe, it may be necessary for a doctor or healthcare provider to examine your child. If you suspect a broken bone or if the tip of a finger or toe has been severed, take your child to an Medical center or emergency department immediately.
What to Do First for a Nail Injury
Frequently, finger and toenail crush injuries result in similar harm and are managed similarly. For most nail crush injuries, it is advised to:
– Clean the affected finger or toe with soap and water.
– Remove any rings from the finger or toe before swelling occurs.
– Immediately immerse the finger or toe in cold water or apply an ice pack. This will help halt bleeding and might prevent a hematoma from developing under the nail.
– Apply pressure with a clean cloth, paper towel, or gauze to the bleeding area.
– Elevate the injured finger or foot above your child’s heart level to alleviate throbbing pain.
For severe nail injuries, seek immediate care at an urgent care center if:
– There is a cut or tear in the nail.
– Bleeding is persistent.
– The nail bed is injured.
At the urgent care center:
– A healthcare professional will clean the nail and assess the nail bed for injuries. Treatment may include:
– Making a small hole in the nail to drain accumulated blood, easing pressure and reducing swelling.
– Removing the nail to properly clean the finger and examine the extent of the injury.
– Using stitches or special glue to repair a nail bed injury.
– Applying a bandage to the injured area.
Post-injury, the nail may fall off even if it has been stitched or glued back into place. Nail regrowth can take up to 9 months. If the nail bed was damaged, the new nail might:
– Develop a bend, crease, or split.
– Not adhere completely to the skin, causing it to lift in places.
– Not regrow entirely.
Fracture of a Bone
Prompt treatment of bone fractures is crucial to prevent future complications. Crush injuries to the fingertip can result in two types of fractures:
– Seymour Fracture: a break in the growth plate.
– Tuft Fracture: a break in the bone at the fingertip.
Both types of fractures are typically managed with a splint or cast to immobilize the bone, allowing it to heal. The splint or cast may need to be worn for a period of 2 to 4 weeks. For toe fractures, treatment may involve:
– Taping the injured toe to its neighbor.
– Using a rigid-soled shoe or splint provided by a doctor or healthcare provider, which prevents the toe from bending.
Partial Amputation
When a finger or toe is partially amputated, it can be alarming, but such injuries often heal well.
First, wrap the injured finger or toe in clean cloth or gauze and apply steady pressure. If the amputated part is available, preserve it by wrapping in clean cloth or gauze, placing it in a plastic bag, and then on ice, and take it with you to urgent care or the emergency room.
Elevate the injured finger or toe above heart level to reduce throbbing pain and bleeding. Seek immediate medical attention at an urgent care or emergency department.
A healthcare professional will:
– Clean the wound, possibly administering pain medication beforehand.
– Apply special stitches to close the wound if possible, which will naturally fall out over time.
– Reattach the amputated piece if available, which serves as a protective cover. This reattached skin may turn black and could eventually fall off.
– Possibly refer your child to a specialist for hand or foot injuries. Surgery may be necessary if a significant portion of the tip was amputated.
What to Do at Home
- Do not remove a bandage, splint, or cast unless it is approved by your child’s doctor or healthcare provider. Ensure that all dressings, splints, and casts remain clean and dry. During the follow-up appointment, you will receive wound care instructions if necessary. Your child should avoid the following until the doctor approves:
– Participating in sports, including gym classes.
– Lifting, pushing, or pulling heavy objects.
– Running, jumping, or engaging in rough play. Stick to low-energy activities.
Your child may experience pain for one to three weeks. Administer over-the-counter pain medications like acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®), following the correct dosage on the label. Avoid giving aspirin or aspirin-containing products. The injured finger or toe may be immobile during healing. Occasionally, your child might need to perform specific exercises to strengthen and increase the flexibility of the affected digit.
When to Call the Doctor
Contact your child’s doctor or healthcare provider if they exhibit any of these infection symptoms:
– Increased pain
– Unpleasant odor
– Persistent redness, red streaks, or swelling
– Thick, yellow, or green discharge from the wound
– Fever or a temperature exceeding 38.6° Celsius
