New York, N.Y.; and Philadelphia, Pa. From the New York University Langone Medical Center, Institute of Reconstructive Plastic Surgery; and the University of Pennsylvania Hospital.
Plast Reconstr Surg. 2013 Jan;131(1):107-112. doi: 10.1097/PRS.0b013e3182729ec2.
Fingertip injuries are the most common hand injuries presenting for acute care. Treatment algorithms have been described based on defect size, bone exposure, and injury geometry. The authors hypothesized that despite accepted algorithms, many fingertip injuries can be treated conservatively.
A prospectively collected retrospective review of all fingertip injuries presenting to Bellevue Hospital between January and May of 2011 was conducted. Patients were entered into an electronic database on presentation. Follow-up care was tracked through the electronic medical record. Patients lost to follow-up were questioned by means of telephone. Patients were analyzed based on age, mechanism of injury, handedness, occupation, wound geometry, defect size, bone exposure, emergency room procedures performed, need for surgical intervention, and outcome.
One hundred fingertips were injured. Injuries occurred by crush (46 percent), laceration (30 percent), and avulsion (24 percent). Sixty-four percent of patients healed without surgery, 18 percent required operative intervention, and 18 percent were lost to follow-up. Patients requiring operative intervention were more likely to have a larger defect (3.28 cm versus 1.75 cm, p < 0.005), volar oblique injury (50 percent versus 8.8 percent, p < 0.005), exposed bone (81.3 percent versus 35.3 percent, p < 0.005), and an associated distal phalanx fracture (81.3 percent versus 47.1 percent, p < 0.05). Patients requiring surgical intervention had a longer average return to work time when compared with those not requiring surgical intervention (4.33 weeks versus 2.98 weeks, p < 0.001).
Despite current accepted algorithms, many fingertip injuries can be treated nonoperatively to achieve optimal sensation, fine motor control, and earlier return to work.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
指尖损伤是最常见的手部急性损伤。已有基于损伤大小、骨暴露和损伤几何形状的治疗算法。作者假设，尽管存在公认的算法，但许多指尖损伤可以通过保守治疗来处理。
对 2011 年 1 月至 5 月期间到贝尔维尤医院就诊的所有指尖损伤患者进行前瞻性回顾性研究。患者在就诊时被录入电子数据库。通过电子病历跟踪随访情况。通过电话询问失去随访的患者。根据患者的年龄、损伤机制、利手、职业、伤口几何形状、损伤大小、骨暴露、急诊室操作、是否需要手术干预以及结局进行分析。
100 个指尖受伤。损伤由挤压伤（46%）、撕裂伤（30%）和撕脱伤（24%）引起。64%的患者未经手术治愈，18%需要手术干预，18%失去随访。需要手术干预的患者更有可能出现较大的损伤（3.28cm 比 1.75cm，p<0.005）、掌侧斜行损伤（50%比 8.8%，p<0.005）、暴露的骨（81.3%比 35.3%，p<0.005）和伴随的远节指骨骨折（81.3%比 47.1%，p<0.05）。需要手术干预的患者返回工作的平均时间长于无需手术干预的患者（4.33 周比 2.98 周，p<0.001）。
尽管目前存在公认的算法，但许多指尖损伤可以通过非手术治疗来实现最佳感觉、精细运动控制和更早地返回工作岗位。
临床问题/证据水平：治疗性，III 级。
