OrthoDx: Fingertip Sensitivity

Slideshow

  • Figure 1. Anteroposterior view of the left hand with injured index finger.

  • Figure 2. Lateral view of the injured distal phalanx.

A 56-year-old man presents to the office 4 weeks after experiencing a crush injury to his left index finger. He reports working in the garage when a heavy object came down suddenly on the tip of the finger. On physical examination the nail is intact and the patient has tenderness to palpation over the tip of his finger. Radiographs of the left hand show a comminuted fracture of the distal phalanx (Figures 1 and 2). The patient is a mechanic and is concerned about his finger sensitivity.

The distal phalanx is one of the most commonly fractured bones in the body. These fractures can cause significant disability with day-to-day activities both in the short- and long-term. The tip of the finger has an abundance of nerves necessary...

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The distal phalanx is one of the most commonly fractured bones in the body. These fractures can cause significant disability with day-to-day activities both in the short- and long-term. The tip of the finger has an abundance of nerves necessary for touch sensation. A crush injury to the nerves and bone can cause the fingertip to remain painful when picking up or pushing down objects with the finger for several months after the injury. Over 70% of distal phalanx fractures will have fingertip sensitivity for up to 6 months; cold hypersensitivity is the most common complaint long-term.1,2

Closed longitudinal fractures have the best long-term prognosis; however, more than 80% of tuft (the most distal aspect of the phalanx) fractures can have symptoms beyond 6 months.1,2 Fibrous nonunion of bones often develop in comminuted fractures with no functional consequences. Distal phalanx fractures rarely need surgical intervention as even the non-unions are asymptomatic. Treatment often involves 4 to 6 weeks of a clamshell-type splint.1,2

References

1. DaCruz DJ, Slade RJ, Malone W. Fractures of the distal phalanges. J Hand Surg Br. 1988;13(3):350-352. doi:10.1016/0266-7681(88)90111-8

2. Lee DH, Mignemi ME, Crosby SN.  Fingertip injuries: an update on management. J Am Acad Orthop Surg. 2013;21(12):756-766. doi:10.5435/JAAOS-21-12-756

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