h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

This is a crush injury. A fingertip trapped by the hinge of a heavy fire door that slammed shut. Xrays show no fracture, however the nail is lacerated right across the top and bleeding was profuse.

We've been told it requires a 'nail bed repair'. This is aparently a procedure where the nail is removed, the underlying tissue repaired then the nail is replaced as a sort of DIY bandage. Fine. I got all that.

The injury occurred at 10am, We spent the day filling out forms at five different departments of two different hospitals. Oh and the wound was dressed... four times. Injured party is 14, hale, hearty, no allergies or illnesses etc.

We were told to report to hospital No. 2 in the Very Early am for the procedure to take place. We have just received a call saying: come, but we doubt we'll be able to fit you in.

Hmm.

We could find alternative ways of having the procedure done but it would take at least a day or two to organise. So here is The Question: what is the window of opportunity for this repair to take place? Anyone have an idea?

Ask your GP?

Is the nail still there, just all squashed/torn? If the nail is removed (the damaged bit) the nail will regrow itself. Did they say what the advantages of the repair were over letting the nail grow out?

Sorry, that doesn't answer your question.


You might have more luck posting on a medical webforum.

The nail should grow back over the crushed area in any case, but can grow distorted and unattractive (and therefore more prone to splitting and getting infected) if the nail-bed is scarred. I don't know what the window for sorting it out is, sorry. I'd take the patient to the appointment and Make A Fuss, especially about how much discomfort the injury is causing and how hard it is for the wounded one to do anything in that state. You may have to wait a long while, but I really can't see any hospital worth squit sending a person in distress away. Could they?

Oops, I've just seen the appointment was for early this morning. How did it go?

Commiserations to the poor injured party - squashed fingers come very high up the list of extremely ouch.

Thanks for the replies, kea and Ag. Well, the procedure did not take place this morning. If my blood pressure comes down sufficiently I may outline the utter, utter chaoes and Total Messing About we experienced this morning. He is now (finally) on antibiotics. This is good. I wanted him on them yesterday but was fobbed off by the A&E Plastics SHO. Today's Plastics SHO was counting off the things that had been done: X ray, dressing, elevation, antibiotics... when I stopped her and said no. No a/biotics. She wasa bit taken aback, to put it mildly.

Anyway. Shan't bore you now. We are booked in (again) to have the procedure on Saturday morning in an adult ward...

However. I have called local private hospital and asked to be allowed a slot at the Plastics clinic this evening with a consultant we had sad occasion to meet ten years ago. he will arrive 15 minutes early to see us. He has a Day Surgery clinic booked at the *other* hospital in the morning... Will report back to you all.

I am sooooo cross. What would I have done if I did not have access to the alternative?

Oh, and the reason for posting the question here is because I got 6 (six) different answers from 6 (six) different health professionals, from General Practitioner to A&E senior nurse all the way up to Plastics SHOs (two of those)

Heigh ho.

Which probably means they don't know Not unusual unfortunately.

Good for you for sorting it all out. Assertiveness goes a long way in the health system. Hope it all works out well.

Unfortunately there isn't always one definitive answer for medical matters. I agree that some of those consulted wouldn't have enough expertise to give an adequate opinion. Others might have a differing opinion on the best action, depending on their experience/training/perception of the situation.

It's easy to see how frustrating this can be. Hope you get it all sorted satisfactorily in the end.

I got my answer. Nail bed repairs can be done at any time, so the advice we have now received (from a Plastics consultant) is to leave well alone. If the nail comes through particularly badly, then we can do the repair.

Best money I ever spent



W

I'm glad you got your answer, Wilma. I hope it wasn't too expensive, though

Eh Mags... rather the money than the alternative.

What I really did not want is for him to have to go through a pretty invasive procedure which would create a new and more extensive wound for healing. At present, the nail has snapped about 80% across, however, it is still fully attached to the nail bed. What they wanted to do, was take the nail off, file down the flesh and stitch any (if..) laceration. Then they were going to put the nail back on to keep the bed flat.

It is a single pinkie finger nail, and it is actually not as bad as it could have been. There is no fracture, if it grows back with a wobble, so what!? As Ag or kea said above, if it grows back awful and prone to infections or other problems, he can still have the repair done. I thought it was such a waste of NHS resources to be insisting on the procedure.

It was a very interesting couple of days. We made contact with no less than eight departments of two hospitals and were seen/processed by seventeen individuals - with all the requisite paperwork, of course. Not one of them knew that there was no time limit for the bed repair. Not one of them had the gumption to say: actually it is really not so bad. Why not just leave it be and see what happens?

Meh.

It sounds a lot like what I did with my big toe many moons ago. I'd dropped my Core A-level maths book on it (huge frelling waste of paper that it was ). The nail was bergered and I actually broke the toe 'course this was over twenty years ago and the docs didn't do much at all then. The toe and nail are both absolutely fine now, though.

S is very prone to disgusting nail damage. Once he stubbed his big toe so hard the entire nail ripped almost right off. We taped it down over the nail bed and left it until it fell off. By that time a new, very distorted and lumpy nail was growing in underneath. It was distorted for about an inch, and then started growing in smoothly as the nail-bed healed and now you can't tell which toe he did it to. Also, he sliced a nail off on a mandolin while shaving parmensan for a Christams dinner for 70 (vertically down from tip of finger to knuckle - oh Lor', I nearly heaved just writing that down, and I was the one who went pea-green and slid to the floor as he was having it dressed in Casualty). They stuck that back down, fully expecting the nail-bed to be traumatized beyond repair, and it took splendidly and now all you can see is a neat white line across the top of his finger.

I have no idea why doctory types these days are so reluctant to say 'Go home and don't poke it - it'll be fine'. It's usually true.

Fingers crossed for the perfect healing of the squashed finger.

Thank you both for your good wishes

Oddly enough it was his daddy that lost the plot over 'his' () and his awful injury. Boy himself has been an absolute star through it all.

'his son' - don't know where that word went...

>>I have no idea why doctory types these days are so reluctant to say 'Go home and don't poke it - it'll be fine'. It's usually true. <<

Because when we use common sense and don't order exepensive tests, unnecessary X-rays and at least three "second opinions" we will be sued, reported to the control bodies and threatened to lose our authorisations....

The US-onian habit of malpractice suits and heavy damage compensations are hanging over us like the sword of Damokles nowadays.

Some five years ago the junior association in the Icy North did an investigation and found out that some 20-25 % of all tests etc. were done to "cover yourself" just in case you should be reported to the Board that assesses medical neglience. That board has the habit of considering everything NOT explicit written in the patien's medical records as not been thought of or done.

For instance, a teen age girl comes to you and complains about pain in the lower part of the stomach one day every fourth week, the first day of her period. After examing and talking to her you're sure that she suffers from menstral cramps and prescribe a suitable painkiller to take that day.

End of story?

Nu-uh!

To satisfy the bureacrats and malpractice activists you perferably should have done a full family history, semi-invasive procedures to exclude peptic ulcers; inflammatory bowel disease and rectal cancer. Taken a lot of blood tests and maybe an ultra sound examination or an X-ray as well. Of course you would end this with a two page write up and offer her regular controls at least every six months....

...and you still wonder why really sick people don't get the health care they need?


desillusioned, retired into

And then there's the other side of these situations. It may be a miracle my wife is still alive... but it's certainly NOT a medical miracle. Consider:

- At age seven, she went to the hospital a few times over five days, and each time she was sent home with a diagnosis of a flu. Then finally, someone looked at a test result and sent an ambulance to her home to get her. Meningitis. Thanks to it going unchecked for so long, she got to spend several painful days in a hospital bed while they drained fluids from her brain and spine. It had a tremendous effect on her performance in school long after the recovery.

- At age 13 she began her periods, and things were definitely not normal. No matter who she saw at the doctor's office, she was just sent home with a pat on the head and a Midol. By the time she was successfully diagnosed with endometriosis, 12 years had passed, scarring had ravaged her pelvic area, and the pain was so bad she could barely stand to walk. Employment was unthinkable.

- Endometriosis treatments had a side-effect of recurring kidney infections. Because medical staff don't recognize any kind of kidney infections other than the type that starts as a urinary tract infection and works its way upwards, they insisted on seeing the signs of a UTI before prescribing antibiotics. So she was left to allow the infection to work its way DOWN the tract in order to be able to provide the kind of evidence they were looking for, allowing the pain to grow exponentially over a long 3-5 days. And after it had happened a few times, she knew what was happening and there were documented instances in her medical folder, but nobody wanted to listen.

And I won't even bother you with the details of complications regarding getting pregnant, and then delivering the child, which were brought about by the endo, and which were disastrously mishandled by medical personnel.

Flaws in the system?

- A five-minute conversation with a doctor is insufficient for most problems, but that's usually all you get.

- Overwhelming conceit on the part of the medical community. The idea that "I went to school for 7 years, and you don't know anything" is idiotic. Book learning will only take you so far, and in the end the only one with any reliable information is the patient... they're the only one who knows what their body is doing.

- When you see a GP for a problem, instead of "diagnosis," they should call it a "guess." In the rest of the scientific community, when we encounter problems we work to come up with an informed hypothesis of what is going wrong... but unlike the medical community, we actually TEST it first. It seems absolutely absurd to me how many diagnoses are allowed to go uncorroborated. I'm not allowed to do that, because if I did, thousands of people would lose their money. But nobody is going to DIE.

Now, I've never had a problem like that myself, but that's because I'm articulate, do a little homework before I walk in, and am ready to tell the doctor they're wrong if they go wandering down some tangent. That gets me a subconscious reaction that I might actually have something to add of value, so they actually listen when I talk. My wife, on the other hand, is shy and easily intimidated, and doctors are intimidating people, so she tends to say little. The doctors treat her like an idiot.

I have had the same experience with ths below paragraph you wrote.

Would insisting on a urine culture each time in the future help? Is that allowed? So mant times they just do a dip stick or quick look
It did work in my case , though they acted put out it saved me a lot of time and was more accurate - just a thought.

Repeated paragraph-
"Because medical staff don't recognize any kind of kidney infections other than the type that starts as a urinary tract infection and works its way upwards, they insisted on seeing the signs of a UTI before prescribing antibiotics. So she was left to allow the infection to work its way DOWN the tract in order to be able to provide the kind of evidence they were looking for, allowing the pain to grow exponentially over a long 3-5 days. And after it had happened a few times, she knew what was happening and there were documented instances in her medical folder, but nobody wanted to listen."