Our hands and fingers are constantly exposed during daily tasks, placing them at high risk for injury. Crush injuries result from high-energy trauma, affecting people of any age. According to Hand, the majority of hand trauma injuries in children are to the fingertips. Traumatic crushing finger injuries are also common in the workplace. Finger function is vital for most daily tasks, and crush injuries must be addressed immediately for optimal recovery.
Mechanism of Injury
Traumatic crush injuries are caused by high-impact forces applied to the fingers. Children frequently sustain a crush injury when a finger is slammed in a door. Heavy objects dropped on the fingers, hands caught in machinery and automobile accidents can also cause crush injuries.
Traumatic crush injuries require immediate medical treatment. In the emergency room, the finger is thoroughly examined. Visual assessment of the skin, nail, blood flow, tendons and bones is performed. Severe internal injuries can be masked if the skin is still intact. Each side of the finger is touched lightly to assess for sensory nerve damage. Tendons are assessed by asking the patient to move the finger, although this is not always possible until the finger has been numbed to reduce pain. X-rays detect fractures in the bone. Crushed fingers that do not require surgery are splinted for four to six weeks to allow the bones to heal.
Open crush injuries -- fingers that are missing skin or have amputated parts -- often undergo initial surgery in the emergency room. Once the finger has been numbed, it is thoroughly scrubbed to remove any contamination or debris to prevent infection. Dead tissue or tissue that cannot be salvaged is removed. Damaged blood vessels are repaired next to reestablish circulation in the injured finger. Broken bones are realigned and stabilized with temporary pins called K-wires, or plates and screws. Damaged tendons and ligaments may be repaired during this surgery, or additional procedures may be required at a later time. The wound is left open and covered with a sterile dressing. Within 48 to 72 hours after initial surgery, a second surgery is often performed to assess for any remaining contamination or infection. Tendons or nerves that weren't initially repaired are addressed with this surgery. Skin grafts -- in the superficial layer of skin -- may be required to cover the injured finger. Skin is frequently taken from an adjacent finger, forearm, abdomen, thigh or groin.
Rehabilitation after traumatic finger crush injury is vital. Physical and occupational therapists who specialize in hand therapy work with patients after these injuries to restore as much function as possible. Treatments include wound care, range of motion exercises, strengthening exercises for grip and pinch, scar management and functional retraining for activities of daily living. Exercises target the entire upper extremity, as all the muscles weaken when the hand is not being used. Therapy is often required for several months after a crush injury.
- Indian Journal of Plastic Surgery: Principles in the Management of a Mangled Hand
- Iowa Orthopaedic Journal: Digital Soft Tissue Trauma: A Concise Primer of Soft Tissue Reconstruction of Traumatic Hand Injuries
- Hand: Bilateral V-Y Rotation Advancement Flap for Fingertip Amputations
- Indian Journal of Orthopaedics: Fingertip Injuries
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