Clinical Assessment and Initial Care of Fingertip and Nailbed Injuries Urgent message: Whether required due to a crushing blow or close contact with a sharp surface, proper initial care for fingertip and nailbed injuries is essential to good outcomes and can often be administered in the urgent care setting. Scott M. Zimmer, MD Introduction ingertip injuries are one of the most common conditions seen in urgent care and emergency room settings. From door crush to table saw injuries, the proper initial care is vital in the long-term result. The goal is a fingertip that has minimal pain, good sen- sation, and adequate soft tissue coverage. Treatments range from simple cleansing with healing by secondary intention to bone-shortening and primary closure. The goals of this article will be to foster understand- © Anatomical Travelogue / Photo Researchers, Inc. ing of fingertip and nailbed anatomy, common injury patterns, and proper initial care. F Anatomy A simple understanding of the anatomy is necessary for w w w. j u c m . c o m proper initial treatment. In addition, it allows the ur- gent care physician to con- vey the nature and severity of the injury to the hand specialist. This communi- cation is key to long-term success because, often, the urgent care physician will simply need to provide wound care and proper fol- low-up. The pulp at the end of a digit is highly specialized tis- sue and consists of fibrous and fatty tissue that has septa extending from the skin to the distal phalanx. The nail unit is made up of the nail plate and the nailbed (Figure 1). Beneath the nail iplate, the nail bed is divided into the sterile matrix and the germinal matrix. The germinal matrix is the proximal region of the ma- trix demarcated by the crescent-shaped region seen at the JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | N o v e m b e r 2 0 0 8 11