Northwestern University Feinberg School of Medicine

Orthopedic Teaching

Hand Case 8 History/Physical Exam

Fingertip Avulsion

History and Physical Exam

History should gather information to determine which amputations are suitable for reimplantation and which are particularly prone to infection. Some details are: time of injury, mechanism of injury, hand dominance, tetanus status, past medical history, and occupation.

The amount of soft tissue soiling and damage should be noted visually. Look for any devitalized tissue which may require debridement and inspect closely for exposed bone (this may be easier after obtaining hemostasis). Observe the amount of remaining nail matrix; if less than 5 mm, the nail is unlikely to regrow and should be removed.