Late diagnosis and treatment of crush injuries of the fingertip in children

Is Fixing Pediatric Nail Bed Injuries With Medical Adhesives as Effective as Suturing?: A Review of the Literature

OBJECTIVES

Nail bed injuries are common in children, with nail bed damage accounting for 15% to 24% of fingertip injuries. Our objective was to see whether medical adhesives, the cyanoacrylates including Histoacryl and Dermabond, could be used to fix nail bed lacerations as opposed to doing a primary repair with sutures, thus potentially being a quicker method for repair in the emergency department for these injuries.

METHODS

We conducted a literature review using the search engines MEDLINE, PubMed, Web of Science, and Google Scholar, and the references within these articles were also integrated. All articles in English were searched. Search terms included "nail bed repair," "nail bed laceration repair," and "cyanoacrylate."

RESULTS

A total of 6 articles were found using the previously mentioned search terms. Four articles using 2-octyl cyanoacrylate or Dermabond for the repair of nail bed injuries were found, with 2 additional articles describing the use of Histoacryl-n-butyl-2-cyanoacrylate-for nail injury repairs.

CONCLUSIONS

The 6 articles discussed in this article include approximately 118 patients' worth of data including a mix of adult and pediatric patients. Despite the small numbers and variety of types of study, it is encouraging that there are so many positive results. Cryoacrylates such as Dermabond or Histoacryl maybe useful to assist with nail injuries in children. Therefore, we feel that using a medical adhesive is as effective as suturing nail bed injuries in children.

Case report of nail bed injury after blunt trauma; what lies beneath the nail?

INTRODUCTION

A stable, mobile and sensate fingertip is of paramount importance to perform daily tasks and sense dangerous situations. Unfortunately, fingertips are easily injured with various extents of soft tissue damage. Delayed and inadequate treatment of nail bed injuries may cause substantial clinical problems. The aim is to increase awareness about nail bed injuries among physicians who often treat these patients.

PRESENTATION OF CASE

We present a 26-year-old male with blunt trauma to a distal phalanx. Conventional radiographs showed an intra-articular, multi-fragmentary fracture of the distal phalanx. At the outpatient department the nail was removed and revealed a lacerated nail bed, more than was anticipated upon during the first encounter at the emergency department.

DISCUSSION

Blunt trauma to the fingertip occurs frequently and nail bed injuries are easy to underestimate. An adequate emergency treatment of nail bed injuries is needed to prevent secondary deformities and thereby reduce the risk of secondary reconstruction of the nail bed, which often gives unpredictable results.

CONCLUSION

However, adequate initial assessment and treatment are important to achieve the functional and cosmetic outcomes. Therefore awareness of physicians at the emergency department is essential.

Finger injuries caused by power-operated windows of motor vehicles: an experimental cadaver study

The aim of this experimental cadaver study was to investigate which kinds of lesions could occur in jam events between the glass and seal entry of power-operated motor vehicle side door windows at two different closing forces. Ten hands of fresh cadaver specimens were used. Three different hand positions chosen to simulate real events in which a finger is jammed between the glass and seal entry of the window of a current motor vehicle were examined. The index, middle, ring, and little finger of each hand were separately jammed both at the proximal and distal interphalangeal joint at closing forces of 300 and 500 N with a constant window glass closing speed of 10 cm/s. Macroscopically visible injuries were documented and radiographs of all fingers were obtained in two standard planes. At a closing force of 300 N, contusion marks of the skin, palmar joint instabilities and superficial skin lesions occurred, whilst at 500 N superficial skin lesions, superficial and deep open crush injuries, and fractures were observed. The results of this study experimentally demonstrate the kinds of finger injuries that could be expected in real jam events between the glass and seal entry in automatic power-operated windows.

Children treated in United States emergency departments for door-related injuries, 1999-2008

This is the first study to provide national estimates of pediatric door-related injuries in the United States. Data from the National Electronic Injury Surveillance System were analyzed for patients ≤17 years who were treated in US emergency departments for a door-related injury from 1999 through 2008. An estimated 1 392 451 US children ≤17 years received emergency treatment for door-related injuries, which averages approximately 1 injury every 4 minutes in the United States. Both the frequency and rate of injury increased significantly. Boys accounted for 55.4% of injuries, and 41.6% of children were ≤4 years. The most common mechanism of injury was a "pinch in the door" (54.8%) or an "impact to the door" (42.0%). Patients admitted to the hospital were most frequently treated for amputations (32.0%) or lacerations (25.2%). The frequency of injuries associated with glass doors increased significantly with increasing age, in contrast to injuries from other types of doors.

[Risk of injury to children's fingers in power-operated motor vehicle windows]

BACKGROUND

This study examines the dimensions of children's fingers and the risk of jam injuries in a 4-mm gap between glass and gasket of power-operated motor vehicle windows.

MATERIAL AND METHODS

The diameter of the proximal, middle, and distal phalanx and of the proximal and distal interphalangeal joint of each finger of the right hand of 160 children was measured in a cross-sectional investigation. Six different drawings in cross section of gaskets and glass window panes of current motor vehicle side door windows at a vertical gap of 4 mm were drawn in correct proportion. The larger actual width of the oblique gap between window glass and gasket was measured and related to the diameters of children's fingers.

RESULTS

Almost all fingers and joints fit in the largest actual gap of 18 mm between glass and gasket of one seal design.

CONCLUSION

The European guideline 74/60/EWG specifications currently pertaining to closing force restriction do not eliminate the risk of potentially serious injury to children's fingers in motor vehicle power windows.

Management of uncomplicated nail bed lacerations presenting to a children's emergency department

OBJECTIVE

This study examined the mechanisms of injury and the pattern of care for children who presented to the emergency department with uncomplicated nail bed lacerations.

METHODS

A retrospective chart review was conducted from January 2004 to December 2007 for all children younger than 18 years who presented to a tertiary children's hospital with an uncomplicated nail bed laceration.

RESULTS

There were 84 cases of uncomplicated nail bed injuries for more than a 4-year period. Sixty percent of the subjects were males. The mean age was 5.3 (SD, 4.1) years. Most injuries occurred at home (58%), and the most common mechanism of injury was a door (67%). Approximately 40% of patients were treated by emergency physicians. There was no significant difference in acute and chronic complications or in the length of stay in the emergency department, between patients treated by emergency physicians and by plastic surgeons.

CONCLUSIONS

Most nail bed injuries in children occur at home, and the door seems to be the major mechanism of injury. Approximately 57% of these are children younger than 5 years. Only 42% of uncomplicated nail bed lacerations are treated by emergency physicians, yet there is no significant difference in outcomes between plastic surgeons and emergency physicians. Our study suggests that there is a role in public education for primary prevention, and with proper training, pediatric emergency physicians can treat uncomplicated nail bed lacerations.

Lengths, girths, and diameters of children's fingers from 3 to 10 years of age

We obtained data on the lengths, girths, and diameters of the fingers of children from 3 to 10 years of age. A total of 160 children (78 girls, 82 boys) were examined in a cross-sectional investigation. The length of each finger of the right hand of every child was measured, as were the girths of the proximal, middle, and distal phalanges, and of the proximal and distal interphalangeal joint. The average length of the thumb was 49 (35-65) mm. The index and ring fingers both averaged 69 (index, 50-88; ring, 42-96) mm in length, while the middle and little fingers averaged 72 (57-100) and 56 (40-74) mm, respectively. Average diameter, calculated from the girth measurement, was 16 (11-22) mm for the thumb, 15 mm for both the index (9-22) and middle (10-21) fingers, 14 (10-20) and 13 (8-19) mm for the ring and little fingers, respectively. The average length of each finger increased by 37% from 3 to 10 years of age, average girth by 24%, and diameter increased by 20%. We observed no differences in length, girth, and diameter between the sexes. The dimensions of children's fingers are relevant to injuries from automatic, power-operated window lifters of motor vehicles because risk of injury to a finger jammed between an ascending window and the seal entry depends upon the diameter of the finger. Additionally, short fingers of young children can be jammed over almost their entire length in the oblique design of a car window seal entry.