Fingertip avulsion

(Redirected from Fingertip laceration)


  • Due to blunt or penetrating trauma

Nailtip Anatomy

A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin.
  • The perinychium includes the nail, the nailbed, and the surrounding tissue.
  • The paronychia is the lateral nail folds
  • The hyponychium is the palmar surface skin distal to the nail.
  • The lunula is that white semi-moon shaped proximal portion of the nail.
  • The sterile matrix is deep to the nail, adheres to it and is distal to the lunule.
  • The germinal portion is proximal to the matrix and is responsible for nail growth.

Clinical Features

  • Partial or complete amputation of distal phalanx of finger

Differential Diagnosis

Distal Finger (Including Nail) Injury

Hand and finger injuries



  • Xray

Fingertip Zones

Fingertip avulsion.JPG
  • Zone I - Distal to tip of phalanx
  • Zone II - Between tip of phalanx and lunula
  • Zone III - Proximal to lunula


  • Pain control (Digital block)
  • Irrigate and debride non-viable tissue
  • Replantation rarely indicated for zone I-III amputations
  • Patients more likely to benefit from replantation for thumb and index finger amputations

No exposed bone or nail bed involvement

  • Zone I injuries - treat conservatively with serial dressing changes alone
    • Cover wound with non-adherent dressing
    • Instruct patient to soak fingertip in antibacterial soap-added water for 10min QD and then reapply non-adherent dressing
    • Follow up with primary care provider in 2d
    • Most will have epithelialization in approximately 1 month[1]

Exposed Bone

  • Zone II injuries
    • Consider hand surgery consult
    • Rongeur bone if bony protuberance
    • Trim digital nerves proximal to skin to avoid painful neuroma formation
    • Consider nail removal if significant involvement, possibility of hook nail deformity it damaged nail left in situ
    • Conservative treatment with non-adherent dressing generally preferred[2][3] vs. wound closure with flap
    • Follow up with hand surgery in 3-5d
    • Healing time 3-6wks
  • Zone III injuries
    • Consult hand surgery if available
    • May require distal phalanx amputation
    • Consider treating like Zone II
    • Healing time 3-6wks[1]


  • Generally may be discharged
  • Hand surgery follow-up (especially if zone II or III injury)

See Also

Special Lacerations by Body Part


  1. 1.0 1.1 Lamon, RP, et al. Open treatment of fingertip amputations. Ann Emerg Med. 1983; 12(6):358-360.