John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Before treating the injury, the doctor may numb the
tissue with a local anesthetic such as lidocaine. This is usually done by putting anesthetic in the base of the finger, called a "digital block".
A digital block is done with a small amount of
lidocaine placed on either side of the base of the finger where the main
branch of the nerve is located. This provides anesthesia (numbing) to the entire finger with a minimum amount of needle shots and pain.
If the patient has an open wound such as a laceration or an avulsion, the doctor may want to explore the wound more carefully to assess the damage or to remove foreign bodies.
The wound will then be thoroughly washed.
The nail bed, tendons, or other deep structures are sometimes sutured (stitches are put in) with absorbable (dissolving) thread.
Thread used to close the skin, however, does not
absorb, and stitches will need to be removed in one to two weeks.
Some wounds are just temporarily closed with loose
stitches until the patient can be seen by a hand surgery specialist in a day or two.
Avulsions and amputations
The separated tissue may be able to be reattached to the finger.
A piece of tissue that is very small, is severely
damaged, or has been separated for a long period may not be salvageable.
Reattachment of amputations closer to the base of the finger (more proximal),
especially ones that include the middle part or base of the finger, are more
likely to be attempted by the hand surgeon.
Skin grafting is used in some cases where a large piece of skin is missing.
A large (>50% of nail surface) or very painful patch of blood can be drained from under the nail by "trephination"
Trephination is done by boring a few holes in the
nail to relieve the pressure and drain the blood. This can be done with a
red-hot cautery device (a heated metal probe), a needle twisted through the nail, or a small drill device.
This infection of the lateral nail fold is drained by
putting a small incision in the skin overlying the infected area. It is then
cleaned, and antibiotics are placed on it. Depending on the severity of the infection, the patient may need oral antibiotics.
Fractures and dislocations
Reduction (realignment) of broken or
dislocated bones usually takes place in the emergency department under local anesthesia.
After the bone is put back into place, the doctor may perform more x-rays to make sure the bones are realigned, then a splint is applied.
Some fractures and dislocations require surgery in
the operating room to repair.
Fractures, dislocations, tendon injuries, and some
lacerations may be treated by splinting part of the finger or even the whole
hand or wrist.
This splinting allows the tissues to rest and therefore heal faster.
Some wounds are at higher risk of infection than others and may be treated with antibiotics.
If the doctor prescribes antibiotics, it is very
important that the patient take the medication as directed and finish the
whole prescription even if
the patient feels fine.
Referral to a hand specialist
Certain fractures, tendon lacerations, amputations, and other injuries may be referred to a hand specialist for treatment or for follow-up.