MEDICO LEGAL M A G A Z I N E
FINGERTIP INJURIES IN PERSONAL INJURY By Mr Maxim D Horwitz MBChB FRCS (Orth) DipHandSurg, Consultant Orthopaedic Hand and Wrist Surgeon, Chelsea and Westminster Hospital, London SW10 9NH Maxim Horwitz is a Consultant Orthopaedic Hand and Wrist Surgeon in the Hand Unit at Chelsea and Westminster Hospital where he leads the paediatric hand surgery service. He is also an Honorary Consultant for the Major Trauma Unit at St Mary's Hospital. Mr Horwitz receives instructions from solicitors and insurance companies and acts for both Claimant and Defendant. Drawing on his broad clinical knowledge and in-depth expertise in traumatic injury he is well placed to provide expert witness reports. He can be contacted on E-mail: info@thehanddoctor.co.uk; Website: www.thehanddoctor.co.uk Fingertip and nail injuries are common in the general population, and more common in children, mechanics, carpenters and people who work in manual trades. The tip of the finger is extremely sensitive and when crushed or lacerated can be associated with an injury to the bone, nail bed or nail plate. If appropriately treated, these injuries will often make a good recovery with the following caveats. Despite anatomical repair of the nailbed, the nail may grow with a bump, split or ridge. This will usually result in a cosmetic problem and very rarely a functional one. If there is any loss of bone at the tip of the finger, then the nail may hook over the edge of the finger. The shape or contour of the pulp may change permanently but usually without any functional deficit unless the finger is significantly shorter. The fingertip will often have abnormal sensation for up to a year with persistent redness or swelling for a similar period. Cold intolerance
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and hypersensitivity can last for between two and ten years after an injury, particularly worse in cold weather and may abate but may never completely disappear. The nail takes nine months to take on a normal appearance, colour and shine. Various strategies can be used to take away the sensitivity at the tip of the finger and these include simple massage and desensitising by touching different surfaces. Very occasionally, a neuroma (nerve scar) can occur on the tip of the finger after an open injury. These can be challenging to treat and often respond very well to a course of hand therapy. Trying to excise or remove the neuroma can often move the problem to a different location more proximally up the limb and is not recommended unless it is a last resort. Several problems can occur after a simple fingertip injury. If the patient has extended periods of immobilisation this can result in stiffness of the
