What is it? This section deals with acute or recent injuries, ranging from a bruise or scrape to having the end of the finger taken off.  Treatment of healed or nearly healed fingertip injuries is a different situation. When portions of the fingertip are missing, the injury is usually described as a  partial amputation. When the finger is cut more than halfway through, the injury may be described as a subtotal amputation.  Here are some of the more common types of fingertip injuries and what they are called by doctors: Distal phalanx tuft fracture. Comminuted distal phalanx tuft fracture with subungual hematoma (blood under the fingernail). Subtotal amputation with open fracture and nail bed injury. Palmar oblique fingertip amputation with pulp loss. What caused it? Usually  a cut or crush, caught in a door, window, gear, belt, saw, etc. What can you do to help? Ice, elevation, and have it checked out by a doctor. If the injury involved a cut, medical evaluation is particularly important - to check whether or not a tetanus shot, antibiotics or other treatment is required, even if stitches aren't needed. What can a therapist do to help? A hand therapist can be very helpful in providing a protective splint, guiding special exercises to improve movement and strength, and making the hand feel better in general. However, the most common and difficult problem that people have after a fingertip injury is tenderness or hypersensitivity of the tip. This can be quite disabling. Desensitization exercises, supervised by a hand therapist, are the key to correcting this problem - which otherwise may not go away on its own.  What can a doctor do to help? The exact treatment really depends on the exact type of injury. Injuries may involve skin, bone, fingernail, or any combination, and treatment requires separate consideration of each:  Injury of... Problem Treatment might involve... Skin Cut Let it heal on its own Put in stitches Partly missing Let it heal on its own Skin graft (skin moved from original location)  Skin flap (skin partly connected to original location) Trim the bone back Nail Blood under the fingernail Leave it alone Drain the blood through a hole in the fingernail Remove the fingernail and put in stitches Cut Let it heal on its own Put in stitches Partly missing Let it heal on its own Graft Remove the remaining nail bed: no more nail Bone Broken Splint or cast Temporary metal pin Partly missing Shorten the finger Bone graft   How successful is treatment? The ordeal of recovery as well as the final result depends as much on the person as on the actual injury - two people with basically the same injury can have great differences in pain, stiffness, recovery time and final outcome. Early proper medical care is the best first step towards the best possible outcome.  In rare occasions, a completely amputated fingertip may just be sewn back on, either repairing the blood vessels (microsurgical replantation) or not (composite grafting). Unfortunately, this is usually not nearly as successful as might be expected, particularly in adults or when the tip has been crushed in a door. Even with microsurgery, only a disappointingly small  percent of  fingertip amputations are successfully replanted. Fortunately, there are many options other than replantation that hand surgeons can offer provide a satisfactory result. What happens if you have no treatment? It's a roll of the dice. You may luck out and wind up with a pretty good result. However, if the injury really needs surgery, it's best to do it right away.

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