Smashed Thumb (ER Story)

“If there is bleeding… especially if it’s more than 50-percent of the nail… it should probably be evaluated.”

– Dr. Cedric Miller, Emergency Pediatrics, Children’s Healthcare of Atlanta

It seems like a rite of passage: a smashed finger… a crushed fingernail. In happens to most kids at some point, as they grow up. Typically some ice or a bandage is all that’s required… but not always.

Nine-year-old Carolina smashed her thumbnail while she was at school.

Since Carolina is developmentally delayed, she’s not able to explain exactly how it happened. But the doctor has a pretty good idea. “Most likely a doorway. Perhaps a commode seat,” says Dr. Cedric Miller, an Emergency Pediatrics physician at Children’s Healthcare of Atlanta. “Something that either squeezed or crushed the tip of her finger popped the bottom of her nail out and above the skin. And this is what we call a partial nail evulsion.”

When a nail is smashed, often the nail falls off… only to grow back again. But Carolina’s injury is to the base of her nail.

“The base of the nail separates and protects the area where that nail growth occurs,” explains Dr. Miller. “So that if the base of the nail has been removed, the tissue that normally would regenerate a nail, may not be able to adequately regenerate that nail.”

That’s why the doctor reattaches the nail to the finger… using stitches.

“Now we have repaired the nail bed. We have repaired the cut so it is not separated. The next thing we’ll do is replace the nail, so it can splint the bed,” he says during the procedure. “Her nail’s back in place, and it’s stable enough that even with a little tugging, it’s not going to come out.”

If your child smashes a finger or toe, you may not have to come to the hospital.

“But if there is bleeding that occurs,” warns Dr. Miller, “especially if it’s more than 50-percent of the nail, and there’s blood under the nail. If there is an associated laceration –any other part of the finger is cut or lacerated– if there’s bleeding that doesn’t look like it’s going to stop with simple pressure, or if there’s any significant crush injury to the finger, it should probably be evaluated.”

Bringing Carolina to the emergency room was a good idea. In time, she will grow a brand new nail.

“That nail that we replaced will not stay there. But it will act as a splint, and act as a guide for that new nail to come up,” explains Dr. Miller. “And by repairing it this way, we give her the best chance of having a nice, cosmetic nail at the end.’

A door can cause serious harm for young children. In fact, thousands of children each year are sent to the hospital with fractures or broken bones because their tiny fingers were caught in slamming doors. Often when this occurs, parents are unsure of the severity of the situation. Does a crushed finger require immediate medical attention? What if the finger looks fine? How do you know when a finger is broken? All of these questions are common concerns for many of these parents.

Many times, a smashed finger means a broken finger. Unfortunately, broken bones are often a part of childhood. Experts say it’s important for parents to remain calm during any childhood injury, including fractures. In fact, in the case of broken fingers or toes, the Los Angeles Fire Department urges parents not to call 911. Those calls should be saved for emergencies.

SiIf your child is the victim of a door-slamming accident, he/she may suffer a fracture or broken bone. Be on the lookout for the following symptoms, as cited by the American Academy of Orthopaedic Surgeons:

• Swelling
• Tenderness
• Numbness and tingling
• Inability to move the finger completely
• Deformity
• Extreme pain at the site of the injury
• Pain increased by any movement

If your child displays any of the symptoms mentioned above, it is important that he/she receives immediate medical attention. Often, however, a slammed finger may just look bruised and cut. In some cases, the fingernail may be damaged and require stitches. Determining whether or not your child’s finger injury is serious and whether a torn nail requires stitches can be difficult for any parent. The University of Michigan Health System suggests seeking immediate care for your injured child if the following occurs:

• The skin is split open and may need stitches.
• Blood collects under a nail AND becomes very painful.
• Dirt or grime enters the wound and you can’t clean it.
• The finger can’t be opened (straightened) and closed (bent) completely.

You should wait and call your child’s physician during normal office hours if the following occurs:

• The injury looks infected.
• Your child is not using the finger normally after one week.
• You have other questions or concerns regarding the injury.

Treatment for a smashed finger depends on the severity of the injury. If you determine that your injured child does not need immediate medical attention, you can follow these guidelines from the Mercy Medical Center:

• Apply an ice pack to decrease the swelling.
• Use over-the-counter pain medications to help relieve discomfort.
• DO NOT splint a smashed finger without first consulting your healthcare provider. Decreased long-term finger mobility may result.
• DO NOT try to drain a swollen finger unless your healthcare provider instructs you to do so.

You can’t prevent all accidents, but you can take several steps to minimize your child’s chances of being injured. SafeChild.net offers the following advice for helping to keep your child’s fingers injury-free:

• Use slow, self-closing springs on doors or catches to keep them open.
• Know where children are to avoid closing doors on their fingers.
• Special strips are available to guard the hinge side of doors.
• Use chocks, wedges or catches to keep internal doors from slamming.

Los Angeles Fire Department
American Academy of Orthopaedic Surgeons
University of Michigan Health System
Mercy Medical Center
Consumer Federation of America