Fingertip Crushing Injury with Nailbed Involvement
Crushed fingertips generally follow a recognizable pattern of injury. Resulting in an avulsion of of the nail plate, laceration to the sterile nail-bed matrix, with or without a fracture of the tuft of the distal phalanx and remain attached by the volar pulp so there is some circulation remaining and have a better chance of survival following re-attachment than would a composite graft if the fingertip was completely amputated.
Right middle finger crushing injury in a pediatric patient demonstrating avulsion of the nail plate. There is a laceration of the sterile nail bed matrix which is still attached to the undersurface of the nail plate and the distal hyponychium and volar pulp.
Similar injury to the left ring finger in a child. similarly the nail plate is avulsed and there is laceration of the nail bed matrix with extension on the lateral aspects of the digit. Still attached by the volar pulp.
The nail plate has been removed and the wound margins debrided. This demonstrates volar soft tissue attachment.