Acute Fingertip Injuries in Sudanese Patients: Patterns and Clinical Presentation

Background: Acute fingertip injuries are common and may lead to functional and aesthetic complications if not treated properly. Different types of trauma result in injuries with variable severity and affect certain risk groups. Objectives: To study the high-risk groups affected by fingertip injuries, their etiological factors, clinical features, and wound patterns, and the influence of hand dominance. Study Design: A descriptive study of 103 consecutive patients with 144 acutely injured fingertips. Data Collection/Analysis: We obtained demographic data, occupation, hand dominance, time and cause of trauma, and the presenting symptoms. Further, clinical examination, radiological, and laboratory studies were performed. Wound characteristics were classified according to the pulp, nailbed and bone (PNB) classification. The data were analyzed with the Fisher’s exact test and Chi-square test. Results: A total of 103 patients (88 males, 15 females) presented with 144 injured fingertips. The male to female ratio was 5.8:1, and the mean age was 27.5 years. The age group affected most commonly was 16 - 20 years. There was a strong association between hand dominance and fingertip injuries, as in 65% of the cases, the dominant hand was injured more frequently than the non-dominant (p = 0.01). The sharp and blunt injuries observed involved the left hand more than the right and were often the result of machinery-related trauma (p = 0.04). Approximately 68% of the injuries were related to work, while 26% were attributable to domestic accidents. In 22% of the cases, seasonal workers were the category affected most often, followed by factory workers. Nearly half of the injuries were related to working with machines, while door-trapping was the most frequent cause of injury in children under 5. The index finger was injured most frequently (31.9%), followed by the middle finger (27.9%), while the thumb and little fingers were involved least (11% for each). Pulp injuries were seen in 97% of cases, commonly with lacerations (39.6%, n = 139) while complete pulp loss was seen in 12.6% of cases. 87% of the cases were nail bed injuries, often with nail bed lacerations (28.6%, n = 126), while complete nail bed loss was observed in 9.5% of cases. Tuft fractures were the commonest bone injuries (26%), while complete bone loss was seen in 7.7% of the injured bones (n = 104). Conservative management was carried out on 9% of fingers, while the others required various methods of surgical repair. Nail bed repair was performed in 48.8% of cases (n = 126), while bone fixation was required in 20.2% (n = 104). Conclusions: Fingertip injuries are highly common in practice. In our study, the age, gender, mechanism of trauma and hand dominance had their influence on the pattern of injury. Finally, wound characteristics determine the type of management required.