Original Article The Journal of Hand Surgery (Asian-Pacific Volume) 2020;25(2):199-205 • DOI: 10.

1142/S242483552050023X

Experience with the Use of Splint Caps for the Management

of Fingertip Amputation Injuries
Hannah Jia Hui Ng*, Jane Sim†, Vanessa Hwee Ting Tey*, Sellakuddy Selvaganesh*,
Cheyenne Kate Pueblos Rebosura*, Vaikunthan Rajaratnam*
by UNIVERSITY OF NEW ENGLAND on 04/25/20. Re-use and distribution is strictly not permitted, except for Open Access articles.

*Hand and Reconstructive Microsurgery Service, Department of Orthopaedic Surgery, Khoo Teck Puat Hospital,
†
Department of Occupational Therapy, Khoo Teck Puat Hospital, Singapore
J Hand Surg Asian-Pac Vol 2020.25:199-205. Downloaded from www.worldscientific.com

Background: Fingertip amputation injuries are common hand injuries amongst all ages. If occurring as a result of workplace ac-
cidents, these injuries has the potential to lead to significant socioeconomic costs. Non-surgical techniques can treat these injuries
with the potential to alleviate the burden of these socioeconomic costs. The aim of our study is to describe an alternative, cost-
effective device to manage fingertip amputation injuries, and to present our short-term outcomes with this treatment modality.
Methods: A retrospective study of patients with isolated fingertip amputation injuries who received treatment with semi-occlusive
dressing and splint cap from 1 February 2018–21 December 2018 was conducted. The semi-occlusive dressing used was UrgoTul.
The splint cap is a 3-dimensional thermoplastic splint to cover the semi-occlusive dressing of the injured finger.
Results: There were 28 patients and 31 digits. The average age was 39.9 ± 12.7 years. 89.3% were male, 75% were foreign
workers, 96.4% were blue-collared workers, 40% had dominant hand injuries and 25.8% had nailbed involvement. The average
duration of follow-up was 66 ± 37.4 days and the average duration of hospital leave was 6.5 ± 4 weeks. The splint cap was applied
for an average of 18.1 ± 6.2 days. The total time for tissue regrowth was 27.5 ± 8.8 days. 14.8% had residual nail deformities and
return of sensation took 31.5 ± 11 days. Grip strength was 82.5% of unaffected hand. The mean range of motion at the distal inter-
phalangeal, proximal interphalangeal and metacarpophalangeal joint was 58.8 ± 21.3°, 86.9 ± 15.5°, 81.4 ± 6.0° respectively, and
63.9 ± 23.6° and 66.3 ± 17.3° at the interphalangeal and metacarpophalangeal joint of the thumb respectively. Cost analysis will
be further elaborated in the paper.
Conclusions: Fingertip amputation injuries have a potential for regeneration through healing by secondary intention under semi-
occlusive dressing conditions. The splint cap provides an easy to fashion, cost-efficient and comfortable addition to semi-occlusive
dressings for fingertip injuries.

Keywords: Semi-occlusive, Fingertip injuries, Amputation

INTRODUCTION
Fingertip amputation injury is defined as an injury to
Received: Jun. 14, 2019; Revised: Aug. 31, 2019; Accepted: Sep. 15, 2019
Correspondence to: Hannah Jia Hui Ng
Hand and Reconstructive Microsurgery Service, Department of
Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central,
Singapore 768828
Tel: +65-6555-8000, Fax: +65-6602-3700
E-mail: hannahnjh@gmail.com
the distal phalanx of the finger with soft tissue loss, dis-
tal to the insertion of the extensor and flexor tendons.1)
Fingertip amputation injuries are common hand injuries
amongst all age groups, and fingertip injuries as a result
of workplace accidents have the potential to lead to sig-
nificant economic costs associated with treatment, time
off work, as well as functional disability.2) It is important
to preserve the length of the finger, reconstruct the ap-
pearance of the fingertip and to restore the function of
the finger, especially sensation.2-4)
Optimal management of fingertip injuries has been
 200
Hannah Jia Hui Ng, et al. Experience with the Use of Splint Caps for the Management of Fingertip Amputation Injuries
a much debated topic amongst hand and orthopaedic
surgeons, where options include healing by secondary
intention, primary closure, skin graft, acellular dermis,
and local or regional flaps.1,3,4) The treatment option is
often chosen by the surgeon in consultation with the pa-
tient, based on patient factors such as the nature of the
wound and the patient's individual needs, and surgeon
by UNIVERSITY OF NEW ENGLAND on 04/25/20. Re-use and distribution is strictly not permitted, except for Open Access articles.
factors such as the surgeon's technical expertise.4) How-
ever, studies have demonstrated consistently satisfactory
and comparable results between nonsurgical and surgical
treatment options.5-9) Authoritative texts have also advo-
cated treatment of all digital tip injuries with no exposed
bone nonoperatively, and in injuries with exposed bone,
J Hand Surg Asian-Pac Vol 2020.25:199-205. Downloaded from www.worldscientific.com
advocate treatment by rongeuring a small portion of the
phalanx with healing by secondary intention.4)
Some of the non-surgical techniques allow heal-
ing by secondary intention, and this includes the use of
self-adhesive semi-occlusive dressings such as OpSite®
Flexifix® film (Smith and Nephew, London, UK) and
IV3000 (Smith & Nephew, London, UK).9-13) Recently,
Schultz et al. designed a silicone finger cap as an alterna-
tive semi-occlusive dressing.7,14) With the semi-occlusive
dressing, healing has been proposed to occur by a num-
ber of mechanisms. The moist environment promotes
pro-regenerative effects of important cellular and soluble
factors. The moist environment also supports wound epi-
thelialisation by retaining growth factors that stimulate
cell migration and cell division, maintaining increased
oxygen partial pressure and encouraging epidermal mi-
gration.11,14)
However, self-adhesive semi-occlusive dressings are
occasionally challenging to apply especially if the skin
is wet.14) The silicone finger cap is not universally avail-
able.14) An alternative device was designed using a ther-
moplastic splint and semi-occlusive dressing, termed the
splint cap, for the management of fingertip amputation
injuries. The purpose of our study was to describe our
cost-effective technique with the use of these splint caps
for the management of fingertip amputation injuries, and
to present our short-term outcomes with this treatment
modality.
METHODS
In this retrospective cohort study, all consecutive
patients who sustained a fingertip injury and attended
to the hospital’s Accident and Emergency Department
between 1 February 2018 to 31 December 2018 were
included in the study. The inclusion criteria were all pa-
tients 18 years old and above, who had sustained isolated
fingertip injuries. All patients were referred to the Hand
Surgery Service of the hospital. All fingertip injuries
were classified according to the Allen Classification, us-
ing the description in case files, clinical photos as well as
radiographs performed at the time of injury.1) All Allen
I-IV injuries were included in this study. Demographic
and treatment data were obtained from medical files.
Patients were excluded from this study if they were
less than 18 years old, if they required or qualified for
critical revascularization of their fingertip injury, termi-
nalization of their fingertip and if they have other finger
or hand injuries which required other forms of surgical
intervention apart from distal fingertip amputation treat-
ment.
The design and application of the splint cap
All patients underwent debridement and application
of splint cap at our hospital’s Day Surgery Centre under
local anaesthesia (LA). After debridement of the finger,
a semi-occlusive dressing (UrgoTul) is applied over the
fingertip injury, where the inherent properties of UrgoTul
will provide non-adherent yet moist environment for
healing to occur. The corresponding finger of the contra-
lateral hand is used as a three-dimensional template to
fabricate a three-dimesional thermoplastic splint using
materials from Orfit Industries. It has a thickness of 1.6
mm and is perforated to cover the UrgoTul dressing of
the injured finger. The thermoplastic splint provides the
support for the tissue to heal in the shape and contour on
the contralateral finger.
Together, the UrgoTul and thermoplastic splint con-
struct is termed the splint cap (Fig. 1). The cost of this
splint cap to the patient is USD$6.00 and takes approxi-
mately 3 minutes to fabricate.
During follow-up appointments, with the initial
appointment on post-operative week 2, the splint cap
construct is removed for inspection of the wound. If the
wound is moist , redressing is performed and the splint
cap reapplied. If tissue regrowth is adequate however
epithelialization has yet to take place, the splint cap is
removed and a simple dressing is applied. the duration of
splint cap usage is recorded. If tissue regrowth is com-
plete and epithelization is complete, no further dressing
is required and the time for this to occur is determined to
be the time to tissue coverage (Fig. 2).
Outcome parameters
At follow up review, objective outcome parameters
such as range of motion, grip strength, sensation and
hospitalization leave were used. Hospitalization leave
 201
The Journal of Hand Surgery (Asian-Pacific Volume) • Vol. 25, No. 2, 2020 • www.jhs-ap.org
by UNIVERSITY OF NEW ENGLAND on 04/25/20. Re-use and distribution is strictly not permitted, except for Open Access articles.
J Hand Surg Asian-Pac Vol 2020.25:199-205. Downloaded from www.worldscientific.com
Wound debridement and
application of semi-occlusive
Injury
dressing and splint cap
in day surgery
If contour has been
Once wound completely
restored, splint cap
epithelialized, no further
dressings needed
removed and semi-occlusive
dressing reapplied
was used as a proxy to return to work time.
Range of motion was assessed according to the
American Society for Surgery of the Hand standards us-
ing a handheld goniometer. The mean active range of
motion of each individual joint and total active range
of motion of the finger was calculated. The power grip
strength was recorded using a precision dynamometer,
and we used the mean value of three measurements for
analysis.15) The mean findings of the injured hand ex-
pressed as a percentage of the mean values of the contra-
lateral uninjured hand.
Sensation was scored with a two-point discrimination
test by using a Disk-Criminator (Dellon) to assess the
sensibility of the injured and contralateral uninjured fin-
gers. The time taken to achieve normal sensation was re-
corded when a score of 1 mm–5 mm, (normal sensation
Fig. 1. Clinical photograph of fabrication
and application of the splint cap.
Wound reviewed in hand
clinic post operatively
If contour has not been
restored, semi-occlusive Fig. 2. Treatment algorithm for fingertip
dressing and splint cap amputation injuries treated with semi-
reapplied
occlusive dressing and splint cap.
of the two-point discrimination test according to Dellon
et al.), was achieved.16) This test was chosen based on
the reliability and the practicality of its use.16)
For subjective outcome parameters, nail deformity
was used. The presence or absence of nail deformity was
recorded by one assessor, one of the authors of this pa-
per, our Hand Occupational Therapist (OT). Possible de-
formities were hook nail, splitting nail, nail hypertrophy,
spike nail, or no nail.
Approval for this review of hospital records was ob-
tained from Institutional Review Board, DSRB 2018/
01120.
Continuous data is presented as mean and standard
deviation (SD), while categorical data is presented as
frequency and percentages. Statistical analysis of the
data was performed on IBM SPSS 23.0 statistical soft-
 202
Hannah Jia Hui Ng, et al. Experience with the Use of Splint Caps for the Management of Fingertip Amputation Injuries
ware (SPSS Inc., Chicago, IL, USA).
RESULTS
Between 1 February 2018 to 31 December 2018, there
were 30 patients with traumatic fingertip amputation inju-
ries who were consecutively managed with the splint cap.
by UNIVERSITY OF NEW ENGLAND on 04/25/20. Re-use and distribution is strictly not permitted, except for Open Access articles.
Two defaulted follow-up and were excluded in the data
analysis.
Demographics
The mean age was 39.9 ± 12.7 years (range 21–63),
where the majority were males (n = 25, 89.3%). Twenty-
J Hand Surg Asian-Pac Vol 2020.25:199-205. Downloaded from www.worldscientific.com
one patients (75%) were foreign workers, and the rest
were Singaporeans (n = 7, 25%). There were 13 Chinese,
9 Indians, 4 Bangladeshi and 2 Malay patients (46.4%,
32.1%, 14.3%, 7.1% respectively). 27 patients (96.4%)
were blue collared workers working with tools as part of
their job, and 1 patient (3.6%) was a retiree. Twenty-six
patients (92.9%) were involved in workplace accidents.
Two (7.1%) were smokers and none of the patients were
diabetic. Injured digits were of the dominant hand in 12
patients (40%).
Nature of injuries
In total, there were 31 injured digits in 28 patients.
Twenty-six patients (92.9%) had a single injured digit,
one patient (3.6%) had two injured digits, and one pa-
tient (3.6%) had three injured digits. Out of 31 injured
digits, 8 (25.8%) were thumbs, 5 (16.1%) were index
fingers, 10 (32.3%) were middle fingers, 7 (22.6%) were
ring fingers and 1 (3.2%) was the little finger. In terms
of the Allen classification of the injuries, 5 were Allen
I, 14 were Allen II, 11 were Allen III and 1 was Allen
IV (16.1%, 45.1%, 35.5%, 3.2% respectively). 21 digits
(75%) had associated distal phalanx fractures, 8 digits
(25.8%) had nailbed involvement requiring nailbed re-
pair during the debridement, and one digit had flexor
digitorum profundus (FDP) tendon insertion injury (10%
laceration) which did not require repair.
Treatment and follow-up
The splint cap was applied for a mean of 18.1 ± 6.2
days (range 4–29). The mean duration of follow up was
66 ± 37.4 days (range 28–155). Fig. 3 is of clinical pho-
tographs demonstrating the outcomes with splint cap.
Fig. 3. Clinical photographs showing in-
jury to fingertips (top row) and after use
of splint cap, with full tissue regrowth
(bottom row).
 203
The Journal of Hand Surgery (Asian-Pacific Volume) • Vol. 25, No. 2, 2020 • www.jhs-ap.org
Outcomes
The mean time to total tissue regrowth was 27.5 ± 8.8
days (range 14–50).
Out of 8 digits with nail bed involvement, 4 (50%)
had residual nail deformities. The mean time for sensa-
tion to return was 31.5 ± 11.0 days Seven digits (22.6%)
experienced paraesthesias, of which 6 digits (85.7%)
by UNIVERSITY OF NEW ENGLAND on 04/25/20. Re-use and distribution is strictly not permitted, except for Open Access articles.
were hyperaesthetic, and 1 (14.3%) was hypoaesthetic.
There were no cases of infection, and none of our pa-
tients required repeat surgeries. The average duration of
hospitalization leave was 6.5 ± 4.0 weeks (range 1–19).
The mean ± SD of the range of motion (ROM) at
each joint can be seen in Table 1. The thumb range of
J Hand Surg Asian-Pac Vol 2020.25:199-205. Downloaded from www.worldscientific.com
motion is reflected separately. One patient had extensor
lag of 10° at the DIPJ and 20° at the PIPJ, despite inten-
sive occupational therapy.
Mean grip strength was assessed in 12 patients
(42.9%). The mean grip strength of the affected hand
was 82.5% to that of the unaffected, contralateral hand.
DISCUSSION
96% of the patients were in the young and economi-
cally active age group who are blue-collared workers
and rely on the functions of their hands for their liveli-
hood. These injuries account for the commonest type of
open hand injury seen by our service.
There is an increasing trend towards conservative
treatment of fingertip amputation injuries.10,14) there is a
lack of evidence to support surgical over conservative
treatment, especially since conservative treatment with
dressings and protective splints have proven to result in
satisfactory outcomes in aesthetic, return to work, patient
satisfaction, sensation, grip strength, and range of mo-
tion, associated with lower infection rates and avoidance
of surgical complications.8)
The use of semi-occlusive dressings with or with-
out a protective cap have demonstrated excellent out-
comes.8,9,12-14) There is also a reduced rate of infection
and a reduced inflammatory response postulated to be
Table 1. Range of Motion at the Individual Joints
Joint Mean ± SD (range)
ROM (°)
Distal interphalangeal joint (DIPJ) (n = 23) 58.8 ± 21.3 (15–90)
Proximal interphalangeal joint (PIPJ) (n = 23) 86.9 ± 15.5 (55–110)
Metacarpophalangeal joint (MCPJ) (n = 23) 81.4 ± 16.0 (30–100)
Thumb interphalangeal joint (n = 8) 63.9 ± 23.6 (35–90)
Thumb MCPJ (n = 8) 66.3 ± 17.3 (45–90)
due to the maintenance of normal cellular hydration.14)
Compared to healing by secondary intention which in-
volves contraction of wound edges and epithelialization
of scar tissue, the semi-occlusive dressing affords almost
scar-free healing, with good restoration of soft tissue
volume, sensibility and even skin papillary lines, which
some authors have described as regenerative healing.9)
Furthermore, as opposed to completely occlusive dress-
ings that result in excessive moisture collection and skin
maceration, semi-occlusive dressings maintain injured
fingertips in a moist environment but without the risk of
maceration owing to their high moisture vapour trans-
mission rate.11)
One disadvantage with the use of semi-occlusive
dressings is that self-adhesive semi-occlusive dressings
alone are challenging to apply, especially if the skin is
wet.14) Another disadvantage is that semi-occlusive dress-
ings do not provide sufficient splinting of the injured
finger nor mechanical protection of the wound, resulting
in the problem of constant leakage of malodorous wound
fluid, pain and absence of framework for regeneration.14)
With the protective splint cap, this would allow us
to address the disadvantages with the sole use of semi-
occlusive dressings. Firstly, additional splinting is pro-
vided to the affected finger. Secondly, the splint cap acts
as a mechanical protection of the wound. Furthermore,
patients are allowed immediate range of motion of the
digit post-application of the splint cap and semi-occlu-
sive dressing. The additional splinting of the affected
finger which would reduce the pain patients experience,
encouraging range of movement of the finger. Ulti-
mately, this would avoid the resulting stiffness an poorly
mobilized finger would have, leading to a reduction of
pain associated with stiffness of the finger. As a result,
our patients experienced minimal pain with the use of
this technique. At the final review, patients rated the pain
score of our treatment method based on the Visual Ana-
logue Scale of an average of 0.86 ± 1.6.17)
Another aspect would be the challenges of our local
population include the need to return to work early with
minimal intervention to conserve resources. Surgical
intervention of fingertip amputation injuries can lead to
large additional costs from these surgeries, amounting
to 21 times the splint cap treatment. For example, if a
patient received a V-Y advancement flap under general
anaesthesia, surgical costs alone are estimated to be
USD$1960. If performed under local anaesthesia, surgi-
cal costs are estimated to be USD$1780.
Comparatively, a patient who is seen at the accident
and emergency and is treated with semi-occlusive dress-
 204
Hannah Jia Hui Ng, et al. Experience with the Use of Splint Caps for the Management of Fingertip Amputation Injuries
Table 2. Cost of Semi-Occlusive Dressing and Splint Cap
Mean cost of
appointments
Mean number of doctor 2.68 ± 1.12 USD$113 ± 47
appointments
Mean number of hand 5.75 ± 2.3 USD$266 ± 105
occupational therapy
by UNIVERSITY OF NEW ENGLAND on 04/25/20. Re-use and distribution is strictly not permitted, except for Open Access articles.
appointments
Accident and emergency cost USD$93 (inclusive of
semi-occlusive and
splint cap application)
Total cost USD$470
J Hand Surg Asian-Pac Vol 2020.25:199-205. Downloaded from www.worldscientific.com
ing and a splint cap faces a bill of USD$93.
Furthermore, post-surgical intervention, patients
are typically immobilized and would require frequent
review. This results in a prolonged rehabilitation time,
adding on to economic costs associated with increased
time of hospitalization, need for more rehabilitation ses-
sions and possible subsequent functional disability.
The use of a splint cap on top of the semi-occlusive
dressing would address the above problems, as the splint
cap is easy to apply, provides splinting of the injured fin-
ger, allows immediate range of motion of the digit post-
application of the splint cap and finally, is cost-effective.
The following table, Table 2, demonstrates the cost
of management of fingertip amputation injury with
semi-occlusive dressing and splint cap in our population.
We use the rates that private patients are charged in our
government institution, given that 75% of our patient
population are foreigners. We also demonstrate the cost
of management of fingertip amputation injury with V-Y
advancement flap in our patients in Table 3. The average
cost of treatment with semi-occlusive dressing and splint
cap is USD$470 (inclusive of accident and emergency
department costs). Comparatively, the average cost of
fingertip amputation injuries treated with a V-Y ad-
vancement flap faces a cost of USD$2875 for treatment.
Although patients who have V-Y advancement flap have
a lower average of hand occupational therapy appoint-
ments likely due to the fact that patients wounds heal
within 2–3 weeks and regain range of motion faster due
to less immobilization, the surgical costs associated with
this method are already far greater than the total costs of
the semi-occlussive dressing and splint cap.
This preliminary study has demonstrated comparable
outcomes with the use of the splint cap. Total tissue re-
growth took an average of 4 weeks, 12.9% had nail de-
formity, return to sensation took an average of 4.5 weeks
Table 3. Cost of V-Y Advancement Flap
Mean cost of
appointments
Mean number of doctor appointments 3.31 ± 1.62 USD$140 ± 34
Mean number of hand occupational 4.69 ± 3.7 USD$218 ± 171
therapy appointments
Accident and emergency cost USD$87
Surgical costs USD$1960
Total cost USD$2875
(although 25% had paraesthesias, which were reportedly
tolerable), there were no cases of infection, grip strength
was 82% to the contralateral hand and return to work
was at an average of 6.5 weeks. Furthermore, all patients
were satisfied with this treatment method, and were
satisfied with the cosmetic outcome. All patients would
choose this treatment method if they were given a choice
between surgical and splint cap treatment.
This is a single arm study, thus no conclusion can
be drawn regarding superiority in treatment outcomes
compared to surgical intervention. Also, as this is a pilot
study examining the outcomes of the usage of splint cap,
the study may have been underpowered. Further, we had
a relatively short follow-up period as in our local con-
text, patients typically stop returning for clinical reviews
once they are able to return to work at full duties.
A larger case matched and controlled clinical trials is
currently ongoing to evaluate the benefits of nonsurgical
management of traumatic fingertip amputation injuries
with the splint cap, compared to surgical management.
Fingertip injuries have a potential for regeneration
through healing by secondary intention under semi-
occlusive conditions. Our novel technique using the
splint cap provides an easy to fashion, cost efficient and
comfortable addition to semi-occlusive dressings for fin-
gertip injuries.
CONFLICT OF INTEREST
All authors have no conflicts of interest to declare.
FUNDING
No funding was received for this work.
REFERENCES
1. Allen MJ. Conservative management of finger tip injuries
in adults. Hand. 1980;12(3):257-65.
 205
The Journal of Hand Surgery (Asian-Pacific Volume) • Vol. 25, No. 2, 2020 • www.jhs-ap.org
2. Overton DT, Uehara DT. Evaluation of the injured hand.
Emerg Med Clin North Am. 1993;11(3):585-600.
3. Tang JB, Elliot D, Adani R, Saint-Cyr M, Stang F. Repair
and reconstruction of thumb and finger tip injuries: a global
view. Clin Plast Surg. 2014;41(3):325-59.
4. Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen
MS, editors. Green’s operative hand surgery. Seventh edi-
by UNIVERSITY OF NEW ENGLAND on 04/25/20. Re-use and distribution is strictly not permitted, except for Open Access articles.
tion. Philadelphia, PA: Elsevier; 2017.
5. van den Berg WB, Vergeer RA, van der Sluis CK, Ten Duis
H-J, Werker PMN. Comparison of three types of treatment
modalities on the outcome of fingertip injuries. J Trauma
Acute Care Surg. 2012;72(6):1681-7.
6. Hutchinson JJ, McGuckin M. Occlusive dressings: a mi-
J Hand Surg Asian-Pac Vol 2020.25:199-205. Downloaded from www.worldscientific.com
crobiologic and clinical review. Am J Infect Control. 1990;
18(4):257-68.
7. Schultz J, Leupold S, Grählert X, Pfeiffer R, Schwanebeck
U, Schröttner P, et al. Study protocol for a randomized con-
trolled pilot-trial on the semiocclusive treatment of finger-
tip amputation injuries using a novel finger cap. Medicine
(Baltimore). 2017;96(41):e8224.
8. Krauss EM, Lalonde DH. Secondary healing of fingertip
amputations: a review. Hand. 2014;9(3):282-8.
9. Hoigné D, Hug U, Schürch M, Meoli M, von Wartburg U.
Semi-occlusive dressing for the treatment of fingertip am-
putations with exposed bone: quantity and quality of soft-
tissue regeneration. J Hand Surg Eur Vol. 2014;39(5):505-
9.
10. Matsumoto MK, Fernandes M, de Moraes VY, Raduan
J, Okamura A, Belloti JC. Treatment of fingertip injuries
by specialists in hand surgery in Brazil. Acta Ortop Bras.
2018;26(5):294-9.
11. Ha NB, Chang AC, Sullivan JS, Leonello DT. Non-opera-
tive management of fingertip injuries with an intravenous
dressing. J Wound Care. 2015;24(6):276-9.
12. Germann G, Sauerbier M, Rudolf KD, Hrabowski M. Man-
agement of thumb tip injuries. J Hand Surg. 2015;40(3):
614-22; quiz 623.
13. Germann G, Rudolf KD, Levin SL, Hrabowski M. Finger-
tip and thumb tip wounds: changing algorithms for sensa-
tion, aesthetics, and function. J Hand Surg. 2017;42(4):274-
84.
14. Schultz J, Schröttner P, Leupold S, Dragu A, Sußmann S,
Haase M, et al. Conservative treatment of fingertip injuries
in children - first experiences with a novel silicone finger
cap that enables woundfluid analysis. GMS Interdiscip
Plast Reconstr Surg DGPW. 2018;7:Doc05.
15. Mathiowetz V. Comparison of Rolyan and Jamar dyna-
mometers for measuring grip strength. Occup Ther Int.
2002;9(3):201-9.
16. Dellon AL, Mackinnon SE, Crosby PM. Reliability of two-
point discrimination measurements. J Hand Surg. 1987;
12(5 Pt 1):693-6.
17. McCormack HM, Horne DJ, Sheather S. Clinical applica-
tions of visual analogue scales: a critical review. Psychol
Med. 1988;18(4):1007-19.