Door-related Fingertip Injury in Preschool Children: A Simple Treatment Method in the Emergency Department

Objective: To present a feasible treatment method of pediatric nail and nail bed laceration, which could be performed in the emergency room.
Methods: Twenty-one pediatric patients who presented to the emergency department of our institute with a fingertip injury were analyzed retrospectively. The detached flap at the fingertip was reduced and fixed with 25-g needle tip. Four-zero prolene, PDS, silk, or monocryl were used. The wound was sutured at the bilateral edges of the paronychial region while holding the distal interphalangeal joint. An additional second suture was added from the proximal nail to the eponychium. If the nail was completely separated from the matrix, a 4th suture was added to the hyponychial region at the distal nail. Six-month patency of the fingertips following repair was the primary outcome measure of this study.
Results: During a mean follow-up of 6.4 months, no fingertip necrosis developed and revision surgery was not required in any patient. No nail deformity requiring further treatment was found at the last follow-up.
Conclusion: This study demonstrates that fingertip injuries developing because of door pinching in preschool children can be treated under local anesthesia in the emergency room without repair of the nail bed. This approach seems to be a valid and safe alternative to surgical repair under general anesthesia.