Finger tip injuries in children
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MS Orth, European Diploma Hand surgery Consultant Hand, wrist and microsurgeon Bai Jerbai Wadia Hospital for children Kusum superspeciality orthopedic centre,Mumbai 7738729068 bipinghanghurde@gmail.com Most common injuries in children are door crush injuries Jammed fingers
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Finger tip injuries in children
- 1. Finger tip injuries in children Retrospective analysis of 12 cases Dr Bipin A Ghanghurde Consultant Hand, wrist surgeon MS Orth, European Diploma Hand surgery Consultant Hand, wrist and microsurgeon Bai Jerbai Wadia Hospital for children Kusum superspeciality orthopedic centre,Mumbai Surya Hospital, Mumbai 7738729068 bipinghanghurde@gmail.com
- 2. Function of finger tip •Tactile sensibility – Normal 2-point discrimination between 3 and 4 mm •Aesthesis •Pinch
- 3. Anatomy of finger tip •Dorsal nail fold -the shine of the nail. •The nail bed consists of the sterile and germinal matrix. •The germinal matrix is responsible for 90% of the nail growth.
- 4. Cause of injury Door crush
- 5. Included Injuries •Simple lacerations •Complex stellate lacerations •Avulsion injuries •Amputations
- 7. Allen’s classification for finger tip amputation
- 8. Aims and objective • To find the sensibility of the finger tip in children after reposition of finger tip or flap cover at follow up. • To find the rate of nail growth after surgery for finger tip following crush injury. • To asses the cosmetic outcome of finger tip at follow up
- 9. 12 finger tips Partial finger tip injury-8 Total amputations- 4 Allen type 3 Allen type 2 Allen type 3 Allen type 4
- 10. Material and methods •Cause of injury 11- door crush • 1- mixer injury •Mean age 4.6 years (1 year to 8 years). • Average follow up 7 months (3 month to 15 months).
- 11. Assesement •2 Point discrimination at follow up (> 6 yrs children) •Nail growth was assessed every week •Parent satisfaction •Nail deformity was assessed at final follow up
- 12. X ray •Tuft fracture •Indicates underlying nailbed injury
- 13. Nail bed repair
- 14. Surgical technique V-Y (dorsal oblique).
- 15. Surgical technique Cross finger flap (Transverse)
- 17. Treatment given for amputations Level of amputation Direction of amputation Surgery performed 1 Allen type 3 Transverse Cross finger flap 2 Allen type 2 Dorsal oblique V-Y plasty 3 Allen type 3 Transverse Kutler’s 4 Allen type 4 Oblique amputation Oblique triangular flap
- 18. Results •Number of patients – 12 (8 – nail bed laceration, 4 – tip amputations) •9 healed well •One developed tip necrosis due to tight suturing •One had flap loss, nail deformity and needs re-surgery. •One had loss of nail shine. •All tuft fractures healed.
- 19. Results •The average time for nail plate to regrow - average 2.27 month(1.5 to 3.5 months) •2 PD elicited in 7 patients average 5mm (4mm- 6mm) •None had pain •None had stiffness of finger •Parent satisfaction- Good
- 20. Nail growth 15 months 20 days
- 21. Nail growth 5 months 2 months
- 22. VY flap 1 month
- 24. V-Y plasty follow up 14 months
- 25. Complication - Tight sutures for nail bed repair
- 26. Cross finger flap 8 months Loss of nail shine
- 27. Flap loss on the tip hook nail
- 28. Take home •Crush injuries of finger tip in children should be meticulously treated. •Pulp reposition and nail bed repair gives good results with near normal nail without deformity •Allen type 3 and 4 amputations have high chances of nail deformity. •All finger tips achieves good sensibility – When treated properly
- 29. Thank you