This document summarizes a study on the use of semi-occlusive dressing and splint caps for the management of fingertip amputation injuries. The study aimed to show that fingertip injuries can be treated conservatively with comparable results to surgical management like V-Y plasty. It was a prospective study of 20 patients with fingertip amputations who underwent splint cap treatment. The results found that splint caps provided a pain-free environment for healing, with outcomes comparable to surgery but at a much lower cost. Further large-scale studies are still needed to validate splint caps as a viable alternative to surgery.

1. Experience with the use of semi-occlusive dressing and
splint caps for the management of fingertip
amputation injuries
Singapore Orthopaedic Association 41st Annual Scientific Meeting
1st – 3rd November 2018
Rebosura Cheyenne Kate Pueblos1, Amir Adham Bin Ahmad1, Hannah Ng Jia Hui1,
Sellakkuddy Selvaganesh1, Vaikunthan Rajaratnam1
1Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore

2. 2
Introduction
Spyropoulou, Georgia-Alexandra & Shih, Hsiang-Shun & Jeng, Seng-Feng. (2015). Free Pulp
Transfer for Fingertip Reconstruction—The Algorithm for Complicated Allen Fingertip Defect.
Plastic and Reconstructive Surgery - Global Open. 3. 1. 10.1097/GOX.0000000000000569.

3. 3

4. • Financial burden to society
– USD1195 (2014)
• NIOSH in the United States conducted
a survey across multiple emergency
departments (1982)
– 25.7% of its workload.
– 1.6% had amputations of one or more
fingers
4
Coleman PJ, Sanderson LM. Surveillance of occupational injuries
treated in hospital emergency rooms – United States, 1982. Morb Mortal Wkly Rep Surveill Summ 1983; 32:31SS-37SS
Yorlets, R. R., Busa, K., Eberlin, K. R., Raisolsadat, M. A., Bae, D. S., Waters, P. M., Taghinia, A. H. (2017). Fingertip Injuries in Children:
Epidemiology, Financial Burden, and Implications for Prevention. HAND, 12(4), 342–347. https://doi.org/10.1177/1558944716670139

5. • Prove that fingertip injury can be treated
conservatively
• Results comparable to surgical management?
eg. V-Y plasty
5
Aims

6. • Prospective study of fingertip amputation injuries to the distal
phalanx of the finger who underwent splint cap
• Inclusion criteria:
– fingertip injury with / without bony involvement
• Exclusion criteria:
– other injuries
– <18 yrs old
– fingertip injuries who opted for other type of management e.g. V-Y
plasty
• Day surgery facility under LA
• Jan 2018 – July 2018
6
Materials & Methodology

7. • Demographic
• Occupation
• Mechanism of
injury
• Classification
(Allen)
• Duration of:
–Follow up
–Splint cap
–Tissue healing
–2 point
discrimination
–MC
7
Variables measured

8. • Mean age: 38.9
(range 22 - 62)
• Flaps:
–6x > expensive
8
Results
20
2
Gender
Male Female
Mean Cost (SGD)
Splint cap 700.26
V-Y plasty 4061.27

9. 9
11
4
7
Occupation
Construction worker
Factory worker
Others
19
3
Demographic
Foreign worker Local resident
Results

10. 10
16
3
1 1
Mechanism of injury
Machinery
Crush
Fall from height
Cut by knife
2
12
8
Classification
Allen 1 Allen 2 Allen 3

11. 11
Krauss EM, Lalonde DH. Secondary healing of fingertip amputations: a review. Hand (New York, NY). 2014;9(3):282-288. doi:10.1007/s11552-
014-9663-5.
0
10
20
30
40
50
60
70
80
90
100
Follow up
(15-66)
Splint cap
(11-38)
Tissue healing
(14-40)
5mm 2 point
discrimination
(14-59)
MC
(4-79)
Duration (days)
Our study Krauss et al

12. 12

13. • Preliminary result
– viable alternative with excellent outcomes
• Pain free
• Provides environment for healing to occur
• Cost effective
• Limitation
– Small sample size
13
Discussion

14. • Further study needed
– Innovative grant (INNOVRPG085)
– Qualitative PREM study with various options in fingertip injury
patients.
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