Fingertip in Door (ER)

“Ewww,” exclaims
Dr. Mike Ziegler looking at 10-year-old Jacob’s finger, “well
that’s not much fun. And I’m guessing that it hurts
pretty bad and that’s why you’re here to see us.”

Jacob Amos was walking out of the bathroom at school, when the
door slammed on his finger. “So did you get your finger caught
on the inside of the door, where the hinges are?” asks the
doctor. Jacob nods in pain.

On the surface it looks bad. An x-ray will show what’s
been done to the bone. “His x-ray showed a small, essentially
crack at the tip of his finger,” explains Dr. Ziegler, “once
we identified that he had a fracture, one of the things we were
concerned about was the possibility it could be what’s called
an open fracture.”

An open fracture, a fracture that is exposed which can lead to
an infection in the bone.

“What we’ll do is we’ll clean up the tip of
the finger as best we can, irrigate it out copiously with lots
of sterile fluid. Then put him on a little bit of antibiotic, sort
of protect him against the possibility of infection,” explains
the doctor. And, on top of all of that, anesthesia and a little
distraction so they can stitch up his finger.

He will lose his fingernail. “It’s gonna come off,
there’s not much we can do about that,” the doctor
says. But it will grow back, and in time, Jacob will be just fine.

“Jacob’s finger will likely have significant healing
within a week to ten days,” says Dr. Ziegler, “the wound
itself will probably take 3-4 months before it’s completely
healed and the scar will probably take 6-12 months before it looks
as it’s gonna look in the future.”

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
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.

If your child is the victim of a door slamming accident,
he/she may suffer a fracture or broken bone. Understanding the symptoms associated
with a fractured or broken finger can help determine whether or not your child
should receive immediate medical care. A bone fracture occurs when a break
in the bone exists. Typically, this break is classified into two categories – a
simple, or closed, fracture or a compound fracture. Your child may have a simple
fracture if the bone does not come through the skin or a compound fracture
if the bone pierces through the skin. The American Academy of Orthopaedic Surgeons
cites the following symptoms of a fractured or broken finger:

• 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 or toe 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 health-care
  provider. Decreased long-term finger mobility may result.
• DO NOT try to drain a swollen finger unless your health-care 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. The Consumer
Federation of America 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.