Fingertip Injuries

Updated: Dec 11, 2019
  • Author: Glen Vaughn, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Practice Essentials

The fingertip is the part of the terminal phalanx that is distal to the insertion of extensor and flexor tendons and comprises the nail complex and the glabrous pulp. [1, 2, 3]  Fingertip injuries are extremely common. A functioning fingertip has sensation without pain, stable padding, and an acceptable appearance. Fingertip injuries occur frequently because hands are used to explore surroundings. Common types of injuries include blunt or crush injuries to the fingernail creating subungual hematomas, nail root avulsions, and fractures of the terminal phalanx. Sharp or shearing injuries from knives and glass result in lacerations and avulsion types of soft tissue defects. Burns and frostbite commonly involve fingertips.

(See the image below.)

Significant nailbed injuries can occur from nail r Significant nailbed injuries can occur from nail root avulsions.

The most common causes of fingertip injuries include the following [1] :

  • Crush injury due to forces of compression. This can present as a closed or an open injury and can be associated with distal phalanx fractures. Most children who present with fingertip trauma have experienced a crush injury, usually from the hinge side of a door. [4]
  • A laceration is secondary to a household instrument (knife, scissors, and cans) or works tools (rotatory saw) involving pulp or nail and/or the nail bed complex. 
  • Amputations involve both soft tissue loss and partial or complete distal phalanx loss. Such injuries can cause cosmetic and functional defects.
  • Other injury mechanisms are sudden flexion or extension forces leading to distal tendon avulsion injuries. 

About 10% of all accidents presenting in the ED involve the hand. Hand injuries represent 11-14% of on-the-job injuries and 6% of compensation-paid injuries. They account for approximately two thirds of hand injuries in children. Damage to the nail bed is reported to occur in 15-24% of fingertip injuries. [2]

In a retrospective study by Yorlets et al of 1807 children with fingertip injuries, 50% of fingertip injuries occur in those younger than 7 years, 25% in those aged 7-12 years, and 25% in those aged 13-18 years. Mean age was 8 years, and 59% of the patients were male. The middle finger was the one most commonly affected. The types of injuries were as follows: 43% fractures, 34% nail bed, and 23% amputations. [4]


Ascertain the following information when gathering patient history:

  • Mechanism of injury

  • Hand dominance

  • Occupation and hobbies

  • Length of time since injury

  • Tetanus immunization status

Evaluate the fingertip injury to determine the following [5] :

  • Crush versus sharp injuries

  • Nail or nail bed involvement

  • Bone involvement

  • Viability of tip

  • Presence of foreign body


The goals of treatment of any injured fingertip should be the restoration of a stable interface for object manipulation while looking as normal as possible. At the completion of treatment, the pulp should be stable and pain free, and the nail plate geometry should permit the manipulation of small objects. [6]  Untreated nailbed lacerations may lead to subsequent nail deformities.

Keep the hand elevated. Analgesics may be necessary for the first few days. Radiographs may be necessary either to assess alignment of distal phalanx fractures or to detect presence of foreign bodies. Splint fractures in extension for 2 weeks. Check wound 2 days after ED treatment.

When amputation with loss of two thirds of the nail occurs, half of the fingers develop beaking or a curved nail.

Pediatric digital necrosis resulting in revision amputation has been reported as a complication of Coban digital dressings used to treat fingertip tuft fractures with nail bed lacerations. [7]

Full growth of nail takes an average of 100 days, but fingertip trauma may delay growth by 20 days.

Average healing time for fingertip amputation is 21-27 days.

Remove sutures after 7-10 days.