Hand:finger lacerationMANAGEMENT

TRAUMA PRESENTATIONS · 12 SECTIONS

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529 items

☷ Legend

01Approach to the Critical Patient/attcp49

Immediate priorities

›Immediate stabilization

›If airway compromise

›Standard airway pathway

›Anticipate aspiration with facial bleeding

›If uncontrolled hemorrhage

›Direct pressure

›Tourniquet for exsanguinating extremity bleeding

›If hemodynamic instability

›Massive hemorrhage protocol consideration

›TXA per local trauma protocol

›If altered mental status

›Hypoglycemia check

›Trauma team activation trigger

Limb threat screen

›Limb threatening features

›Active pulsatile bleeding

›Immediate hemostasis

›Immediate surgical consultation

›Expanding hematoma

›Vascular injury concern

›Urgent imaging and consultation

›Pale cool digit

›Ischemia concern

›Emergent hand surgery consultation

›Severe pain out of proportion

›Compartment syndrome concern

›Emergent surgical evaluation

›Partial or complete amputation

›Digit preservation measures

›Emergent consultation and transfer pathway

Pain and anxiolysis

›Analgesia and sedation strategy

›Procedural analgesia readiness

›Local anesthesia planning

›Sedation pathway for pediatric or uncooperative patient

›Non opioid options

›Acetaminophen

›NSAID if no contraindication

›Opioid options

›Short acting opioid for severe pain

›Avoid oversedation prior to neurovascular exam

Neurovascular exam before anesthesia

›Pre anesthesia documentation

›Baseline sensation

›Two point discrimination

›Light touch in digital nerve distributions

›Baseline motor

›Flexor tendon function

›Extensor tendon function

›Baseline perfusion

›Capillary refill

›Pulse oximetry waveform on digit if available

02History/hx52

Mechanism and wound context

›Injury context

›Time since injury

›Delayed presentation threshold by local protocol

›Prior wound care attempts

›Mechanism category

›Sharp laceration

›Crush or avulsion

›Contamination burden

›Soil or farm exposure

›Freshwater or saltwater exposure

›Bite mechanism

›Human bite

›Cat or dog bite

›Glass or metal exposure

›Retained foreign body concern

›High velocity fragment risk

Symptoms and functional loss

›Symptom profile

›Numbness or tingling

›Digital nerve injury concern

›Baseline neuropathy history

›Weakness

›Tendon injury concern

›Pain limited effort concern

›Inability to flex or extend

›Complete tendon laceration concern

›Joint involvement concern

›Bleeding severity

›Arterial injury concern

›Anticoagulant effect concern

Risk factors and immunization

›Host factors

›Diabetes mellitus

›Infection risk increase

›Delayed wound healing risk

›Immunocompromised state

›Steroids

›Chemotherapy or transplant

›Vascular disease

›Raynaud phenomenon

›Peripheral arterial disease

›Medication bleeding risk

›Anticoagulants

›Antiplatelet agents

›Tetanus status

›Prior vaccine series completion

›Unknown or incomplete series

›Completed primary series

›Time since last booster

›Less than 5 years

›5 to 10 years

›High risk wound features for tetanus

›Devitalized tissue

›Contaminated puncture or crush

03Physical Exam/exam56

Wound assessment and exploration

›Wound assessment

›Location mapping

›Volar surface

›Dorsal surface

›Depth estimation

›Subcutaneous only

›Deep to fascia concern

›Margins and tissue loss

›Clean linear

›Jagged avulsion

›Joint proximity

›MCP involvement concern

›PIP or DIP involvement concern

›Exploration considerations

›Irrigation assisted inspection

›Foreign body visualization

›Tendon visualization

›High risk features prompting wider exploration

›Deep wound at flexor crease

›Laceration over known tendon course

Neurovascular and tendon exam

›Neurovascular exam

›Sensory testing

›Static two point discrimination

›Compare to contralateral digit

›Motor testing

›FDP function isolated by holding PIP in extension

›FDS function isolated by holding adjacent fingers in extension

›Extensor mechanism testing

›DIP extension

›PIP extension

›Perfusion testing

›Capillary refill volar pulp

›Nail bed perfusion

›Digital artery injury clues

›Delayed capillary refill

›Poor turgor

›Collateral flow assessment

›Digital Allen test

›Doppler signal if available

Adjacent structure assessment

›Musculoskeletal assessment

›Deformity

›Fracture concern

›Dislocation concern

›Range of motion

›Pain in passive extension

›Mechanical block

›Tendon cascade

›Resting finger posture abnormality

›Malrotation or scissoring

›Infection assessment

›Local infection signs

›Erythema and warmth

›Purulent drainage

›Flexor tenosynovitis features

›Fusiform swelling

›Pain with passive extension

04Differential Diagnosis/ddx35

High risk associated injuries

›Critical associated injuries

›Flexor tendon laceration

›Zone II injury concern

›Partial tendon laceration

›Extensor tendon laceration

›Central slip injury

›Terminal extensor injury

›Digital nerve laceration

›Radial digital nerve

›Ulnar digital nerve

›Digital artery laceration

›Single artery injury

›Bilateral artery injury

›Open fracture

›Distal phalanx

›Metacarpal

›Traumatic arthrotomy

›MCP joint

›PIP joint

Mimics and delayed complications

›Mimics and complications

›Retained foreign body

›Glass

›Wood

›Early infection

›Cellulitis

›Abscess

›Deep space infection

›Thenar space

›Midpalmar space

›Flexor tenosynovitis

›Kanavel pattern

›Rapid progression risk

›Compartment syndrome of hand

›Intrinsic compartment pressure rise

›Pain with passive stretch

05Laboratory Tests/lt26

When labs are needed

›Laboratory triggers

›Systemic infection concern

›Fever

›Tachycardia

›Immunocompromised host

›Neutropenia risk

›Severe diabetes

›Significant hemorrhage

›Syncope or presyncope

›Persistent bleeding despite pressure

Suggested tests by indication

›Targeted tests

›Complete blood count for infection concern

›Leukocytosis interpretation limitation

›Baseline anemia in hemorrhage

›CRP for deep infection concern

›Trend utility

›Low specificity limitation

›Serum electrolytes and creatinine for IV antibiotics planning

›Renal dose adjustment

›Baseline kidney function

›INR for warfarin use with bleeding concern

›Reversal threshold per local protocol

›Procedure planning support

›Point of care glucose for altered mental status

›Hypoglycemia exclusion

›Diabetes screening adjunct

06Diagnostic Tests/dt58

Scoring Systems

›Structured assessments

›Kanavel signs for flexor tenosynovitis suspicion

›Fusiform swelling

›Tenderness along flexor sheath

›Pain with passive extension

›Flexed posture at rest

›Gustilo Anderson classification for open fracture context

›Type I low energy wound

›Type II moderate soft tissue injury

›Type III high energy or extensive soft tissue injury

›Zone based tendon injury localization

›Flexor zones I to V

›Extensor zones I to VIII

MRI

›MRI indications

›Occult tendon injury with equivocal exam

›Partial tendon laceration uncertainty

›Deep muscle injury concern

›Deep space infection concern

›Thenar or midpalmar abscess mapping

›Osteomyelitis concern in delayed presentations

›MRI limitations

›Time and access barriers

›Not first line in typical ED laceration

›Delay risk in ischemic digit

›Metal foreign body contraindication

›MRI safety screening

›Alternative imaging selection

›CT indications

›Complex fracture pattern

›Intra articular involvement

›Surgical planning need

›Radiolucent foreign body uncertainty

›Wood foreign body possibility

›Failure to visualize on radiograph and ultrasound

›CT limitations

›Radiation exposure

›Prefer radiograph first for most cases

›Pediatric risk consideration

›Soft tissue detail limits

›Tendon injury often clinical diagnosis

›MRI or ultrasound preferred for soft tissue

Ultrasound

›Point of care ultrasound uses

›Foreign body localization

›Radiolucent material detection

›Depth and proximity to tendon or vessel

›Tendon continuity assessment

›Dynamic tendon motion

›Partial laceration suspicion

›Vascular assessment adjunct

›Doppler flow in digital arteries

›Comparison to contralateral side

›Ultrasound limitations

›Operator dependence

›Training and experience variability

›Confirmatory imaging selection when uncertain

›Small foreign body miss risk

›High suspicion with negative study

›Repeat evaluation and alternative imaging consideration

07Disposition/dispo39

Consultation and transfer triggers

›Immediate hand surgery consultation triggers

›Suspected tendon laceration

›Loss of active flexion or extension

›Deep laceration over tendon course

›Suspected digital nerve laceration

›Two point discrimination abnormality

›Sharp laceration with sensory loss

›Suspected digital artery injury

›Poor perfusion signs

›Persistent bleeding requiring tourniquet

›Open fracture or exposed bone

›Distal phalanx tuft with nail bed injury

›Gross contamination

›Traumatic arthrotomy concern

›Laceration over joint with deep penetration

›Visible synovial fluid

›Bite involving hand

›Human bite over MCP

›Cat bite puncture with swelling

Discharge criteria and follow up

›Discharge suitability

›Hemostasis achieved

›No recurrent bleeding after observation

›Dressing stability

›Neurovascularly intact

›Normal perfusion

›No new sensory deficit after procedure

›No deep structure injury suspected

›Full active range of motion

›Normal tendon testing

›Reliable follow up

›Suture removal plan

›Hand specialist follow up when indicated

›Follow up timing suggestions

›Hand surgery follow up for complex wounds

›24 to 72 hour window typical

›Earlier if worsening pain or swelling

›Primary care or urgent care for simple lacerations

›Suture removal appointment

›Wound check if contamination

08Treatment/t112

Hemostasis and wound preparation

›Bleeding control

›Direct pressure and elevation

›Pressure dressing

›Recheck perfusion after dressing

›Tourniquet use for brief field control

›Time tracking

›Release for reassessment intervals

›Topical hemostatics for oozing

›Gauze with hemostatic agent

›Avoid packing tightly in digit ischemia risk

›Wound cleansing and irrigation

›Copious irrigation strategy

›Normal saline

›High pressure irrigation for contaminated wounds

›Debridement principles

›Devitalized tissue removal

›Preserve viable skin flaps

›Foreign body removal

›Visible foreign material extraction

›Imaging guided removal when needed

Anesthesia

›Local anesthesia options

›Digital nerve block

›Lidocaine 1 percent

›Bupivacaine 0.25 percent

›Local infiltration

›Small superficial wounds

›Avoid tissue distortion when precision needed

›Epinephrine considerations

›Epinephrine in digital block in selected patients

›Healthy digit perfusion

›Prolonged anesthesia and hemostasis benefit

›Avoid epinephrine when vascular compromise risk

›Severe peripheral vascular disease

›Crush injury with compromised perfusion

Closure strategy

›Closure decision framework

›Primary closure suitability

›Clean wound

›Low infection risk

›Delayed primary closure suitability

›Heavily contaminated wound

›Delayed presentation with contamination

›Secondary intention suitability

›Small fingertip avulsion

›High tension closure risk

›Technique essentials

›Layered closure when deep dead space

›Deep absorbable suture for fascia

›Superficial non absorbable for skin

›Skin suture selection

›Nylon or polypropylene

›Simple interrupted pattern

›Nail bed injury management

›Nail plate replacement as splint when removed

›Absorbable fine suture for nail bed repair

Splinting and function protection

›Immobilization principles

›Splint when crossing joint or tendon concern

›Position of function

›Protect repaired tissue

›Buddy taping for minor stable finger wounds

›Adjacent digit support

›Remove for hygiene per instructions

›Elevation and edema control

›Hand elevation above heart

›First 24 to 48 hours

›Reduce swelling and pain

›Ice application guidance

›Short intervals

›Avoid frost injury

Antibiotics

›Antibiotic decision points

›No routine prophylaxis for clean uncomplicated laceration

›Low infection baseline in properly irrigated wounds

›Shared decision making when risk factors present

›Prophylaxis for high risk wounds

›Bite wounds to hand

›Gross contamination or devitalized tissue

›Treatment for established infection

›Cellulitis around wound

›Purulence or abscess

›Bite wound prophylaxis options

›Amoxicillin clavulanate oral

›Adult dose 875 mg amoxicillin with 125 mg clavulanate twice daily

›Typical duration 3 to 5 days for prophylaxis

›Penicillin allergy alternatives

›Doxycycline plus metronidazole

›Moxifloxacin monotherapy in selected adults

›Open fracture antibiotic pathway

›First generation cephalosporin for low grade open fracture

›Cefazolin dosing per local protocol

›Early administration priority

›Add gram negative coverage for severe open injury

›Gentamicin per local protocol

›Monitor renal function

Tetanus prophylaxis

›Tetanus prevention

›Vaccine indications based on wound type and immunization history

›Clean minor wound thresholds

›Dirty major wound thresholds

›Tetanus immune globulin indications

›Unknown or incomplete immunization with dirty major wound

›Immunodeficiency with non minor clean wound

›Vaccine product choice

›Tdap when never received as adult

›Td for boosters per schedule

Pain control after discharge

›Analgesia plan

›Acetaminophen scheduled or as needed

›Maximum daily dose counseling

›Avoid duplication with combination opioids

›NSAID as needed if no contraindication

›Renal and GI risk counseling

›Avoid in high bleeding risk

›Short course opioid for severe pain

›Small quantity

›Avoid driving and alcohol

09Special Populations/sp30

Pregnancy

›Pregnancy considerations

›Imaging selection

›Radiograph shielding when feasible

›Ultrasound preference for soft tissue questions

›Medication safety

›Acetaminophen preferred first line analgesic

›Avoid NSAID in later pregnancy when possible

›Antibiotic selection

›Beta lactams preferred when indicated

›Avoid doxycycline in pregnancy

Geriatric

›Older adult considerations

›Fragile skin and poor perfusion

›Gentle tissue handling

›Higher dehiscence risk

›Anticoagulant use prevalence

›Bleeding control planning

›Medication review and reversal pathway awareness

›Delayed healing risk

›Longer suture retention planning

›Close follow up scheduling

Pediatrics

›Pediatric considerations

›Cooperation and analgesia needs

›Child life support

›Procedural sedation pathway

›Weight based medications

›Local anesthetic maximum dose calculation

›Antibiotic dosing by weight

›Non accidental trauma consideration

›Inconsistent history

›Pattern injuries

10Background/b30

Epidemiology

›Epidemiology overview

›Common ED presentation

›Occupational and kitchen injuries

›Sports and glass related injuries

›Infection risk modifiers

›Bite wound higher infection rates

›Delayed presentation higher infection rates

›Functional impact

›High risk of missed tendon injury

›High risk of missed nerve injury

Pathophysiology

›Injury anatomy

›Skin and subcutaneous disruption

›Dead space and hematoma formation

›Bacterial inoculation risk

›Tendon injury patterns

›Flexor tendon retraction risk

›Extensor tendon superficial exposure

›Neurovascular injury patterns

›Digital nerve transection causing sensory loss

›Digital artery injury causing perfusion compromise

Therapeutic Considerations

›Key therapy principles

›Infection prevention balance

›Irrigation and debridement primary

›Antibiotics targeted to high risk scenarios

›Function preservation

›Early detection of tendon and nerve injuries

›Immobilization when indicated

›Local anesthetic choices

›Duration matching procedure and pain

›Epinephrine use individualized to perfusion risk

11Patient Discharge Instructions/pdi26

Copy discharge instructions

›Discharge instructions for chart

›Wound care

›Keep dressing clean and dry for first 24 hours

›After 24 hours gentle soap and water rinse allowed unless instructed otherwise

›Activity

›Elevation above heart for swelling for 24 to 48 hours

›Avoid heavy use until cleared

›Splint care if provided

›Keep splint on as directed

›Return if splint feels too tight or fingers become pale or numb

›Pain control

›Acetaminophen as directed

›NSAID as directed if safe for you

›Return to ED now for

›Increasing pain not controlled by medication

›New numbness or inability to move finger

›Fingers turning blue pale or cold

›Spreading redness warmth swelling

›Pus drainage or fever

›Bleeding that will not stop with 10 minutes of firm pressure

›Follow up

›Wound check timing per plan

›Suture removal timing per plan

›Tetanus

›Vaccine update given today if indicated

›Future booster scheduling reminder

12References/r16

Guidelines and key sources

›Evidence and guidelines

›CDC tetanus wound management guidance

›Clean minor versus dirty major wound stratification

›Vaccine and TIG indications by immunization history

›Canadian immunization guidance for tetanus prophylaxis

›TIG plus vaccine recommendation in some immunodeficiency scenarios

›Wound based prophylaxis tables

›Digital nerve block epinephrine safety literature

›Systematic review evidence in healthy digits

›Caution in compromised circulation

›Flexor tendon laceration evaluation references

›Two point discrimination before anesthesia

›Capillary refill and digital Allen test utility

›Bite wound antibiotic prophylaxis references

›Amoxicillin clavulanate first line

›Alternatives for beta lactam allergy

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.