Children’s fingertips get smashed frequently, usually getting caught in closing doors. The child is either unable to recognize the potential danger, or she fails to remove her hand quickly enough before the door is shut. Fingers also sometimes get crushed when youngsters play with a hammer or other heavy object, or when they’re around a car door.
Because fingertips are exquisitely sensitive, your child will let you know immediately that she’s been injured. Usually the damaged area will be blue and swollen, and there may be a cut or bleeding around the cuticle. The skin, tissues below the skin, and the nail bed—as well as the underlying bone and growth plate—all may be affected. If bleeding occurs underneath the nail, it will turn black or dark blue, and the pressure from the bleeding may be painful.
When the fingertip is bleeding, wash it with soap and water, and cover it with a soft, sterile dressing. An ice pack or a soaking in cold water may relieve the pain and minimize swelling.
If the swelling is mild and your child is comfortable, you can allow the finger to heal on its own. But be alert for any increase in pain, swelling, redness, or drainage from the injured area, or a fever beginning twenty-four to seventy-two hours after the injury. These may be signs of infection, and you should notify your pediatrician.
When there’s excessive swelling, a deep cut, blood under the fingernail, or if the finger looks as if it may be broken, call your doctor immediately. Do not attempt to straighten a fractured finger on your own.
If your doctor suspects a fracture, he may order an X-ray. If the X-ray confirms a fracture—or if there’s damage to the nail bed, where nail growth occurs—an orthopedic consultation may be necessary. A fractured finger can be straightened and set under local anesthesia. An injured nail bed also must be repaired surgically to minimize the possibility of a nail deformity developing as the finger grows. If there’s considerable blood under the nail, the pediatrician may drain it by making a small hole in the nail, which should relieve the pain.
Although deep cuts may require stitches, often all that’s necessary is sterile adhesive strips (thin adhesive strips similar to butterfly bandages). A fracture underneath a cut is considered an “open” fracture and is susceptible to infection in the bone. In this case, antibiotics will be prescribed. Depending on your child’s age and immunization status, the doctor also may order a tetanus booster.