Conservative management of fingertip injuries

1. Experience with the use of semi-occlusive dressing and
splint caps for the management of fingertip
amputation injuries
Singapore Orthopaedic Association 41st Annual Scientific Meeting
1st – 3rd November 2018
Rebosura Cheyenne Kate Pueblos1, Amir Adham Bin Ahmad1, Hannah Ng Jia Hui1,
Sellakkuddy Selvaganesh1, Vaikunthan Rajaratnam1
1Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore

2. 2
Introduction
Spyropoulou, Georgia-Alexandra & Shih, Hsiang-Shun & Jeng, Seng-Feng. (2015). Free Pulp
Transfer for Fingertip Reconstruction—The Algorithm for Complicated Allen Fingertip Defect.
Plastic and Reconstructive Surgery - Global Open. 3. 1. 10.1097/GOX.0000000000000569.

3. 3

4. • Financial burden to society
– USD1195 (2014)
• NIOSH in the United States conducted
a survey across multiple emergency
departments (1982)
– 25.7% of its workload.
– 1.6% had amputations of one or more
fingers
4
Coleman PJ, Sanderson LM. Surveillance of occupational injuries
treated in hospital emergency rooms – United States, 1982. Morb Mortal Wkly Rep Surveill Summ 1983; 32:31SS-37SS
Yorlets, R. R., Busa, K., Eberlin, K. R., Raisolsadat, M. A., Bae, D. S., Waters, P. M., Taghinia, A. H. (2017). Fingertip Injuries in Children:
Epidemiology, Financial Burden, and Implications for Prevention. HAND, 12(4), 342–347. https://doi.org/10.1177/1558944716670139

5. • Prove that fingertip injury can be treated
conservatively
• Results comparable to surgical management?
eg. V-Y plasty
5
Aims

6. • Prospective study of fingertip amputation injuries to the distal
phalanx of the finger who underwent splint cap
• Inclusion criteria:
– fingertip injury with / without bony involvement
• Exclusion criteria:
– other injuries
– <18 yrs old
– fingertip injuries who opted for other type of management e.g. V-Y
plasty
• Day surgery facility under LA
• Jan 2018 – July 2018
6
Materials & Methodology

7. • Demographic
• Occupation
• Mechanism of
injury
• Classification
(Allen)
• Duration of:
–Follow up
–Splint cap
–Tissue healing
–2 point
discrimination
–MC
7
Variables measured

8. • Mean age: 38.9
(range 22 - 62)
• Flaps:
–6x > expensive
8
Results
20
2
Gender
Male Female
Mean Cost (SGD)
Splint cap 700.26
V-Y plasty 4061.27

9. 9
11
4
7
Occupation
Construction worker
Factory worker
Others
19
3
Demographic
Foreign worker Local resident
Results

10. 10
16
3
1 1
Mechanism of injury
Machinery
Crush
Fall from height
Cut by knife
2
12
8
Classification
Allen 1 Allen 2 Allen 3

11. 11
Krauss EM, Lalonde DH. Secondary healing of fingertip amputations: a review. Hand (New York, NY). 2014;9(3):282-288. doi:10.1007/s11552-
014-9663-5.
0
10
20
30
40
50
60
70
80
90
100
Follow up
(15-66)
Splint cap
(11-38)
Tissue healing
(14-40)
5mm 2 point
discrimination
(14-59)
MC
(4-79)
Duration (days)
Our study Krauss et al

12. 12

13. • Preliminary result
– viable alternative with excellent outcomes
• Pain free
• Provides environment for healing to occur
• Cost effective
• Limitation
– Small sample size
13
Discussion

14. • Further study needed
– Innovative grant (INNOVRPG085)
– Qualitative PREM study with various options in fingertip injury
patients.
14