Condition	Presentation	Diagnosis		Treatment
Subungual hematoma	Painful, throbbing fingertip History of a crush injury is typical	Discolored nail Radiographs (AP, lateral, oblique) to rule out associated fractures		Subungual decompression through two to three small holes in nail created with cautery unit or heated paper clip Large subungual hematomas (involving ≥ 50 percent of the nail) may require nail removal and nail bed suturing. Splint the fingertip until tenderness subsides.
Nail bed laceration	Painful fingertip with active bleeding	Grossly deformed nail with visible nail fracture and nail bed laceration History of a high-force crush injury or high-speed laceration (i.e., machine press or rotary saw) Nail bed lacerations may be associated with large subungual hematomas (involving ≥ 50 percent of the nail) Radiographs (AP, lateral, oblique) to rule out associated fractures		Nail plate removal with blunt dissection Primary suturing of the nail bed with 6-0 or 7-0 absorbable suture Maintain the space of the nail fold to allow for a new nail plate by placing the original nail or petroleum gauze over the nail bed and into the nail fold for two to three weeks. Refer nail bed lacerations involving distal tip amputation.
Distal phalanx fracture	Painful, swollen fingertip History of a crush injury May have associated soft tissue damage to the finger pulp or nail bed laceration	Radiographs (AP, lateral, oblique) Three fracture patterns: longitudinal, transverse, comminuted		Closed fractures usually will not require reduction unless significantly angulated or displaced. Splint finger for three weeks. Open fractures may require referral unless physician is comfortable and familiar with the reparative process. Refer fractures that are irreducible, unstable or intra-articular and involving one third or more of the articular surface.
Mallet finger	Flexion deformity of the DIPJ Painful, swollen fingertip May have occurred when trying to catch a ball	Inability to extend the distal phalanx at the DIPJ Radiographs (AP, lateral, oblique) Two forms of mallet finger: Tendinous—extensor tendon rupture Bony—bony avulsion fracture of the distal phalanx		Continuous splinting for six to eight weeks DIPJ must not be allowed to drop in flexion during treatment. Bony avulsions involving less than one third of the articular surface can be reduced with dorsal pressure and dorsal splinting for six to eight weeks. Post-reduction radiographs are essential to assess proper alignment. Refer failed nonsurgical treatment, bony avulsions that are irreducible or involve one third or more of the articular surface, or volar subluxation of the distal phalanx.
FDP avulsion (“jersey finger”)	Painful, swollen finger, especially at the volar DIPJ History of failure to grab an object (e.g., football jersey or car door handle) Ring finger commonly involved	Inability to flex at the DIPJ PIPJ and MCPJ flexion preserved Radiographs (AP, lateral, oblique) to assess for tendinous rupture or bony avulsion fracture		Splint finger in comfortable position; refer to hand surgeon as soon as possible.
DIPJ dislocation	Painful, swollen fingertip History of hyperextension injury is common Rare injury	Grossly deformed DIPJ Radiographs (AP, lateral, oblique); dislocations are often dorsal Splint in slight flexion for two weeks.		Reduction with hyperextension and longitudinal traction after digital nerve block