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Upper extremity injuries of the child

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Wounds in children most often require revision with general anesthesia because of the emotional component that makes it difficult to to explore them in the emergency room. We must rule out deep skin lesions, and repair them (27).

  • The ischemia (lack of blood supply) or pulsatile bleeding indicates arterial injury (27A).
  • The paralysis of some muscles, or loss of feeling in some skin territories indicates nerve damage. In younger children, exploring the sensitivity is challenging. Finger wounds can associate a nerve injury that can be diagnosed with the raisins test (27B). The finger immersion in water does not produce the typical skin rugosities.
  • The digital cascade loss of fingers indicates a flexor tendon injury (27A).


Figure 27A. Children 10 months of age, with middle finger entrapment. There is a drop of the finger (digital cascade loss) suggesting a section of the flexor tendons. Furthermore, the finger has lost the pink color, suggesting a blood vessel section.

Inguries and nail crush

Entrapment of the fingertips is one of the most common injuries in childhood, often by the closing of doors.

In addition to the wound of the skin of the fingertips and the tip of the bone of the phalanx, the matrix or nail bed can be damaged.

Damage to the skin is sutured in the usual way, and the bone usually attaches without problems.

If there is a lesion of the matrix or nail bed, the nail might grow improperly. If an injury to the nail bed is suspected, the nail should be removed and repaired by suture thread or tape, in order to avoid problems of progress in the growth of the nail (Fig. 29A). If there is bone loss from the fingertip, due to not having the nail matrix support,the nail deviates downward giving the parrot beak nail deformity (Fig. 29B).



Figure 29A. Sequel of a nail bed injury left unrepaired


Figure 29B
. Parrot beak nail, due to loss of supporting bone.

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