The PNB Classification for Treatment of Fingertip Injuries

Abstract

The PNB classification, which was advocated by Evans and Bernadis, separates the injuries into their effects on 3 components of the fingertip: pulp, nail, and bone. Because each component is subdivided into 7 or 8 items, this can describe fingertip injuries more precisely. Between 1997 and 2003, we treated 381 fingertip injuries (279 males, 102 females; average age, 41.2 years) in our facilities. A 3-digit number was provided for each of the 381 cases in accordance with the PNB classification. We extracted patients in whom amputated tissues did not exist, and predicted the boundary between conservative treatment and surgical treatment by individually comparing the curative results of the same type of injuries. In conclusion, PNB 355-366 and PNB 455-466 were most suitable for surgical treatment, and the boundaries between surgical treatment and conservative treatment were PNB 386 and 666 and 700. The results, which are the criteria for surgical treatment, are summarized as follows; 1) More than two thirds of the distal phalanx remains. 2)The nail bed defect ranges from one third to half. If the defect is more or less than the criteria, the surgical treatment is less significant. Recognition of the boundary and prevention from unnecessary surgical treatment leads to minimum invasive surgery for fingertip injuries.

Fingertip injuries in children treated in Department of Pediatric Surgery and Oncology in the years 2008-2010.

“…There are numerous papers on the treatment and classification of fingertip injuries in adults [9][10][11]. Some of the solutions presented in the literature may not be used in children due to age and size of their fingers [15].…”

“…Przy oce nie kli nicz nej cię żko ści zmian po ura zowych opu szek pal ców bie rze się pod uwa gę czas i oko licz no ści zda rze nia. W ba da niu przed mio to wym zwra ca się uwa gę na roz le głość ob ra żeń, wy li cza jąc uszko dze nia po szcze gól nych struk tur opusz ki; tka nek mięk kich, pa znok cia i pa licz ka kost ne go [9][10][11][12]. Na leży okre ślić lo ka li za cję i geo me trię ura zu ma jąc na uwa dze, któ re pal ce zo sta ły uszko dzo ne oraz jak przebiega płasz czy zna ura zu.…”

“…W pi śmien nic twie do mi nu ją pra ce po świę co ne za opa try wa niu i kla sy fi ka cji ura zów opu szek pal ców u do ro sły ch [9][10][11]. Część z pro po no wa nych roz wiązań nie mo że być za sto so wa na u dzie ci ze wzglę du na wiek i wiel kość pal có w [15].…”

“…Clinical assessment of the severity of injury-related fingertip lesions accounts for the time and circumstances of the accident. Physical examination focuses on the extent of injury, listing injuries to particular structures of the fingertip: the soft tissues, the nail, and the phalanx [9][10][11][12]. Injury location and geometry is established taking into account which fingers have been injured and the plane of the injury.…”

Fingertip reconstruction: study of functional and cosmetic results of various local flaps and grafting techniques in patients attending a tertiary care center in North India

“…5 It would be of value to know the best type of cover; especially for sensory reinnervation as well as for subjective evaluation, cosmetic appearance and freedom from complications since there are conflicting reports on which type of repair is best for sensory and functional return. 1,6 This study was carried out with aim to evaluate incidence of age, sex, site, pattern of injury and to compare the functional and cosmetic results of the various local flap and grafting techniques in finger reconstruction distal to metacarpophalangeal joint.…”