Acute fingertip injuries

The nail is unique to primates as a specialized structure on the dorsum of the distal portion of each finger, thumb and toe. The nail allows for increased sensory perception on the volar pulp by compressing sensory organs against the unyielding nail. The nail is vital for increased prehension which is so unique in primate function. In addition it protects the fingertip and also serves as a temperature regulator. Fingertips are often our first contact with the environment, are one of the most common injuries presenting to a hand surgeon and may seriously impair the abilities of individuals if injured. The fingertip is the most sensitive part of the hand and has a large area of representation in the sensory cortex. The severity of injury to the nail bed is commonly underestimated because the nail conceals the true extent of injury. The consequences of mismanaged fingertip injuries is often manifest in the form of chronic nail and fingertip deformities, which are more difficult to treat than the original injury. It is therefore important for junior doctor to competently assess the patient, appreciate the potential disabilities and to arrange prompt referral to a hand unit. This article discusses the relevant anatomy, physiology and management of acute perionychial injuries.