Emergency Medicine

Orthopaedic Emergencies 301

Cervical Spine Injuries

2 Also refer patients to the orthopaedic team for consideration of open reduc-
tion and internal fixation, if more than one-third of the articular surface of
the distal phalanx has been avulsed.

3 Manage a mallet-finger deformity in a plastic mallet-finger extension splint
for 6 weeks, and refer the patient to the fracture clinic.

Digital nerve injuries

DIAGNOSIS

1 It is mandatory to test for digital nerve function before using any local
anaesthetic blocks.

2 Sensory loss, paraesthesiae or dryness of the skin from absent sweating,
demonstrated along either side of a digit, indicate digital nerve injury.

MANAGEMENT

1 Refer immediately to the orthopaedic team nerve injuries that are:
(i) Proximal to the proximal interphalangeal joint.
(ii) Along the ulnar border of the little finger.
(iii) Along the radial border of the index finger.
(iv) Affecting the thumb.

2 Injuries distal to the proximal interphalangeal joint rarely justify repair
unless local departmental policy differs.

Fingertip injuries

MANAGEMENT

1 Clean and debride injuries of the distal fingertip that are <1 cm in diameter
and that do not involve fracture of the terminal phalanx, under a digital
nerve block (see p. 491).

2 Leave to granulate under a soft paraffin gauze dressing changed after 2 days.

3 Give tetanus prophylaxis.

4 Refer injuries involving substantial soft-tissue loss, distal phalanx exposure
or a degloving directly to the orthopaedic team.
(i) Nerve injury distal to the distal interphalangeal joint does not
warrant repair.

CERVICAL SPINE INJURIES

See page 224.