Open physeal fractures of the distal phalanx of the hallux are the lesser described counterpart to the same fracture of the finger, known by its eponym as a "Seymour fracture". Displaced Salter-Harris phalangeal fractures present with a concomitant nailbed or soft tissue injury. Often these fractures occur in the summer months when open-toe footwear can be worn, however, they may occur indoors as well. Read More
Hoverboards were recently introduced to the US consumer market and experienced rapid popularity. Given the high frequency of musculoskeletal injury with other wheeled recreation devices, we sought to analyze hoverboard injuries in children. A retrospective review of patients with musculoskeletal injury related to hoverboard use was performed at a tertiary care children's hospital. Read More
Introduction: Distal finger replantations are technically difficult operations due to small vessel sizes and narrow field of vision. The results of 25 distal finger replantations performed by dorsal approach are presented. The technical benefits and details of this technique is discussed with a literature review. Read More
Division of Hand Surgery, Department of Surgery, Christine M. Kleinert Institute for Hand and Microsurgery, Kleinert Kutz Hand Care Center, University of Louisville, Louisville, KY. Electronic address:
The reverse cross finger flap is usually performed on patients with deep dorsal digital skin, nailbed, and extensor tendon injuries that cannot be repaired and grafted. These patients will require additional dorsal digital flaps from the adjacent fingers. Read More
Background: To describe treatment methods and complication rates of all open Seymour fractures (Salter-Harris I/II or juxta-epiphyseal fractures of the distal phalanx of the hand with associated nailbed laceration) treated at or referred to a pediatric level 1 trauma center over a 10-year time period. We hypothesized that delayed treatment of Seymour fractures results in higher infectious complication rates.
Methods: We identified all patients treated for open Seymour fractures at the orthopaedic hand clinic at our level 1 pediatric trauma center between August 2002 and December 2012. Read More
Reconstruction of the distal phalanx bone in cases with painful nonunion is a rare and challenging problem. To restore anatomy and to provide a good cover for the bone graft, an intact nailbed is often required due to the proximity of these 2 structures. We present 3 cases of distal phalanx reconstruction performed with a free corticocancellous bone graft from the distal radius and nailbed reconstruction with a homodigital dorsal reverse adipofascial flap based on an exteriorized pedicle that avoids the dissection of the germinal matrix of the nail. Read More
Purpose: To report our experience with the use of a digital artery perforator propeller flap based on a constant distal perforator in the middle phalanx for resurfacing of lateral oblique fingertip amputations.
Methods: Twelve fingertips in 10 patients underwent reconstruction, with a mean follow-up of 8 months (range, 8-12 mo). The size of the flaps ranged from 2. Read More
The treatment of acute peripheral finger injuries is part of the daily routine of surgeons in emergency departments. This article presents the most common forms of peripheral finger injuries and the specific diagnostic and therapeutic aspects. The injuries include incision and tear injuries, injuries to the nailbed, distal extensor tendon injuries, severed flexor tendons of the distal joint, bite injuries, high-pressure injection injuries and amputation injuries of the distal phalanx of fingers. Read More
Purpose: We report our experience, treatment protocol, and 2-year follow-up results of 24 fingertip replantations treated using the artery-only technique without vein or nerve repair.
Methods: We performed a retrospective review of 24 patients who had undergone fingertip replantation at the same center between 2005 and 2011. All patients in this study had complete fingertip amputation at or distal to the distal interphalangeal joint of the fingers or interphalangeal joint of the thumb. Read More
Purpose: To assess the outcomes of our technique involving oblique headless compression screw for arthrodesis of the thumb interphalangeal joint and the distal interphalangeal joints of the other digits.
Methods: A total of 28 joints (19 thumb interphalangeal and 9 distal interphalangeal) in 23 patients with a mean age of 65 years (range, 58-74 y) were retrospectively analyzed. All operations were performed with the Acutrak2 micro-screw. Read More
Radial or ulnar oblique amputations treated by nailbed levelling and local digital flap reconstruction can result in significantly shortened fingertip, narrowed pulp and nail shape distortion. A VY type flap containing bone, sterile matrix, and skin was conceptualised to restore nail and pulp contour for coronal oblique amputations. Technical details and a clinical case are discussed. Read More
Purpose: To report our technique and results with treating fingertip amputations with flaps and simultaneous nailbed grafts.
Methods: We reconstructed 20 fingertip amputations with loss of bone and nail with flaps combined with nailbed grafts. We reconstructed the volar side of the fingertip with a flap, and the dorsal side of the fingertip with a nailbed grafted to the raw inner surface of the flap. Read More
Purpose: This article aims to present a technique for thumb tip amputations using a homodigital soft-tissue/periosteum flap and a portion of the amputated digit.
Methods: Eight patients (aged 21-53 years) with avulsion thumb tip amputations were reviewed. We report a new technique in which a bone and nailbed composite graft was taken from the amputated portion of the thumb and a dorsoulnar flap combined with periosteum was harvested from the first metacarpal and designed to cover the volar bone. Read More
In the last 40 years, childhood hand and wrist injuries have become progressively more common as children have become heavier and more active in high impact sports. The majority of children with such injuries do well, but treatment is not always straightforward. Distal radius fractures, scaphoid fractures, metacarpal and phalangeal fractures, nailbed injuries, and amputations are among the pediatric hand and wrist injuries most often seen by orthopedists. Read More
Purpose: Peripheral nerve injury of the upper extremity frequently causes changes in the thermoregulatory system of the hands and fingers and leads to reports of cold intolerance. In this study, we aimed to measure the influence of median or ulnar nerve injury on cold-induced vasodilatation (CIVD) during prolonged cooling at low temperatures.
Methods: We tested 12 patients with a median (n = 6) or ulnar (n = 6) injury 4 to 76 months after nerve repair. Read More
Flexor digitorum profundus (FDP) zone I tendon avulsion injury is traditionally repaired with a pullout suture technique. More recently, bone anchor sutures have been used as a viable alternative and have largely replaced areas in hand surgery where pullout suture technique was once required. To date, there have been very few complications reported related to bone anchor suture use in FDP tendon reattachment to the bone. Read More
Introduction: We performed an audit to assess frequency of injury to the nail bed and outcomes after repair in a busy paediatric hand trauma clinic.
Subjects And Methods: This retrospective study examines 46 consecutive nail bed repairs over a 6-month period. All notes were reviewed for patient demographics, details of the injury including the operation and aftercare. Read More
The "homodigital distally based" dorsal adipofascial flap has been used by various authors to cover small, complex, dorsal, digital defects. In 2004, Al-Qattan reported on 3 cases in which a "distally based" dorsal adipofascial flap was used in a "cross-digital" fashion. In the current report, we expand on the concept of cross-digital adipofascial flaps in which the flaps are based not only distally but also proximally or laterally located. Read More
Amputations of the fingertip are the most common injuries to the upper limbs, and they cause greatest socioeconomic losses. The first choice of the technique of repair should be the simplest and fastest, with rapid restoration of function and an acceptable aesthetic appearance, and should return the worker to his job rapidly to prevent economic loss. Volar V-Y advancement flaps should therefore be considered first, but unless the dorsal loss is greater than the volar, this first choice of flap cannot be used because of the inadequate donor area. Read More
The main aim of the treatment of fingertip amputations with no indication of replantation was to establish the functional and esthetic construction. The critical point in the utilization of the bone and nail tissue as a graft for reconstruction was to choose a flap that is sufficiently vascular to nourish these grafts. We have performed homodigital artery flaps to cover the bone and nailbed grafts taken from the amputation to restore fingertip function with an acceptable result. Read More
In fingertip amputations, conventional stump plasty provides an almost acceptable functional result. However, replanting fingertips can preserve the nail and minimize loss of function. We investigated the functional and cosmetic results of fingertip replantation at the terminal branch of the digital artery. Read More
This article focuses on disorders of the hand most commonly presented to the practitioner in an emergency setting. An initial review of functional anatomy is followed by discussions of the clinical findings and treatment of fractures, tendon injuries, infections, nailbed injuries, high-pressure injection injuries, and nerve injuries. The information presented in this article provides a basis for proper evaluation, diagnosis, and treatment of hand injuries. Read More
Fingertip and nailbed trauma caused by doors is common in children, occurring when fingers are either shut in the door itself or are trapped in the hinge as the door is closed. An audit was carried out over five months of all fingertip and nailbed injuries due to trauma from a door. One hundred and eighty eight children, 2% of all attendances in this period, had sustained such trauma, 39% of these occurring in children under four years of age. Read More
Crush injuries of the fingertip are common in childhood. In the course of six months seven cases presented to our department, five of which were S III type injuries [Van Beek et al., Hand Clinics 1990; 6(1): 23-35], that is a sterile matrix laceration with a tuft fracture. Read More
In the treatment of substance loss of fingertips it is crucial to maintain functional length and to restore adequate sensibility. By treating those injuries with a semiocclusive dressing according to Mennen and Wiese (1993), we were able to achieve both goals with excellent results, avoiding the necessity of local or regional flaps as well as shortening of bone to achieve primary closure. 82 patients with 85 injured digits were treated either conventionally (primary closure with or without shortening of bone, vaseline gauze dressings: 31 digits) or with semiocclusive dressings (54 digits). Read More
Digital trauma is a common, but often underappreciated, entity in podiatric practice. This article outlines the pathomechanics, diagnosis, and treatment of digital fractures and dislocations as well as injuries to the toenail and nailbed. Read More
Adequate assessment of crush injuries to the hallux is necessary before appropriate management can be initiated. When distal phalangeal fractures of the hallux are detected by routine radiography and subungual hematomas are present, open fractures of the hallux may be overlooked if the physician does not routinely avulse the nailplate. The authors review current modalities for the detection and evaluation of these injuries and present a protocol for treatment. Read More
Nail regeneration was studied in 48 digits replanted after amputation through the distal phalanx. Twenty-seven were amputated through Tamai's zone I, at the nailbed level, and 21 digits were amputated through zone II, proximal to the nail. The nails of 9 digits in zone I and 14 in zone II showed almost normal nail regeneration. Read More
Subungual melanoma is uncommon, and delays in diagnosis and misdiagnosis occur frequently. We describe a 61-year-old black male who presented with a non-healing area in his left thumb nailbed with many of the features of subungual melanoma. However, the patient also had a pathologic fracture of the distal phalanx, leading to some initial confusion about the diagnosis. Read More
Injuries of the fingertip and nailbed require treatment to minimize pain, speed healing, and shorten the time of functional impairment. Alternatives for therapy include simple dressing changes, graft coverage, and flap transposition. The choice of treatment is based on the location and severity of the injury. Read More
Fingertip reconstruction using a dorsal transposition flap was performed on 10 patients who had undergone traumatic oblique amputation (radial or ulnar) through the middle of the nailbed or transversely through the proximal third of the nailbed. All operations were successful, with a small area of tip necrosis in one flap. Flat nail growth occurred in all digits, with an average regrowth of 5 mm from the initial amputated level. Read More
Free nonvascularized toenail grafts have been used to reconstruct congenital or traumatic nail defects of the thumb or finger. Unfortunately, these transfers often result in deformity or atrophy. To avoid these undesirable results, microsurgical free vascularized toenail transfer was performed in 10 patients, 3 for congenital nail absence and 7 for traumatic nail defects. Read More
Photographic documentation of successful surgical correction of two major vertical-type and one horizontal-type split nail is presented. The developmental mechanism of the horizontal-type split nail is discussed. Treatment of the vertical-type split nail with bipedicled subperiosteal nailbed-matrix flaps is described in detail. Read More
One hundred and fifty-five fingertip injuries were treated over a one-year period. Seventy-six patients with 90 fingertip injuries attended for follow-up. Sixty-four of these injuries were suitable for study. Read More
When accidents occur, the hand is the part of the body most often thrust out to lessen the consequences, resulting in a wide array of combinations of soft-tissue and chondro-osseous injuries. Pediatric wrist and hand skeletal injuries discussed in this article include growth mechanism injury, fractures and dislocations, nailbed injuries, fingertip injuries, burns, and frostbite. Read More
Dressings of the raw nailbed tend to adhere and to be difficult and painful to remove. We have compared three types of dressing: polyurethane sponge, paraffin-gauze and replacement of the finger-nail. Assessment of adherence and pain showed that replacement of the nail had significant advantages over the other dressings. Read More
The authors report on a case of subungual malignant melanoma, which developed beneath a split-skin graft. The patient had an accident which caused a pathologic growth of the nail. Eleven years later the patient removed the nail, because it became moist, and a surgeon grafted the nail-bed with a split-thickness skin. Read More
To satisfy the demands of tactile gnosis, it is necessary to have intact fingertips. For this purpose, the fingernail has an important function. With the help of an example of a nailbed transplantation after a complete amputation of a finger end, a possibility of reconstruction of injured fingertips, especially of the nailbed, is shown. Read More
The primary care physician has a profound influence on the prevention of deformity and disability resulting from fingernail injuries. Prompt recognition and precise repair of the disrupted nailbed consistently result in successful nail restoration. For injuries with a substantial subungual hematoma or a displaced phalangeal fracture, optimal treatment requires removal of the nailplate, reduction of the fracture, and meticulous repair of the nailbed. Read More
1. The majority of our residents who completed their training since 1974 use a microscope for nerve repairs. A majority of those doing microscopic nerve repairs also repair noncritical vessel injuries with the microscope. Read More
By careful technique the dorsum of the thumb can be used as a donor area to cover exposed bone of index fingertip amputations and, in certain cases, avulsions of the nailbed. In this procedure an oblique, radially based flap from the dorsum of the proximal phalanx is used. Read More
We have developed a photoplethysmographic technique for monitoring early signs of vascular compromise in extremities affected by direct vessel trauma, crushing trauma, or circumferential burns. The technique consists of positioning a small infrared emitter-detector array shielded from room light over a nailbed of the affected extremity and connecting the array to standard electronic monitoring equipment, thus producing a pulse tracing very similar in contour to an arterial pressure wave. In normal volunteers, simultaneous observations of the tracing and studies of muscle blood flow using Xe133 clearance showed correspondence of disappearance of the plethysmographic signal with limb-threatening levels of ischemia produced by inflation of a blood-pressure cuff. Read More
V-Y plasty was performed in 28 patients who suffered from a transverse amputation of the finger tip. Bilateral V-Y plasty was carried out in 16 cases and single volar V-Y plasty in 12 cases. The average follow-up period was 32 months. Read More
Three pediatric hand injury subtypes and their management have been presented. Finger tip injuries, while often minor and self-healing in children, may require surgical repair if the nailbed is disrupted or if there has been significant skin or pad loss from the tip. The decision between local repair and skin graft or pedicle reconstruction depends on the nature and extent of the injury. Read More