Crushed Finger Sub-Total Amputation

[CanadianBoy]

Hello
My 4yr Crushed his finger in the door it was 60-70% amputated the finger was intact but crushed it exploded out the side the tip of the bone was broken a closed break I assume.
I asked the RN if we should call in the surgical team for a assessment but they said if the doctor determined it was too complicated he would. He did not and sowed it bak together last night.
The doctor indicated that if the vascular flow was not to the tip it would die and need to be removed. I would think we should have had a vascular surgeon look at it but they did not.
what should I do now I am worried about the tip.

[Jeffrey S Guy, M.D., M. Sc.]

In the US, hospitals that accept Medicare need to have a surgeon on call for emergencies.   It is likely that a surgeon was on call, but not called.  At present, the important thing is to focus on getting your child the best care from this point forward.   Not knowing the extent of the soft tissue / vascular injury or type of fracture it is impossible to comment in the best course of action.   If this were my child you want a hand surgeon.  Even if an amputation is required, you nee a physician following along, that is aware of how a hand is to rehabilitate and what actions to take should there be contractures or abnormal healing.  

[CanadianBoy]

Can you comment on why no surgeon was provided by my hospital. Remember this is childrens hospital in london ontario canada and is world renown.
Now they will have to re injur it to correcct it willl this cause him more injury in the long run?
Thanks
Derek

[Jeffrey S Guy, M.D., M. Sc.]

I am sorry about the trauma your son has experienced.  This is clearly a limb threatening injury that has the potential to impact the functional outcome of the hand.   With an injury to the hand the function of the hand is the most important element in recovery.  

[CanadianBoy]

Ok the doctor's and nurse at the hospital ER refused to let us have a surgeon there. We requested on before the doctor sowed it together.
Then my spouse and I went in the next night because I was worried about it. And we requested a surgeon again and they would not get one. We took him to the family doctor and he was outraged and auto said he needs a surgeon look at it and also the other hospital and they could not believe it either.
Now we have to wait for a surgeon to be found by the referal.
I am suing the hospital. Any thoughts as to why they would not with a 4yr and a 70% subtotal amputation. I am furious. The family doctor said the finger the way it is now will be deformed.

Derek

[Jeffrey S Guy, M.D., M. Sc.]

All injuries to the hand are very serious.   The space shuttle has a robotic arm, but they cannot reproduce the human hand.  You want the opinion of a surgeon who has completed a fellowship in hand surgery. These surgeons are typically orthopedic or plastic surgeons who has additional training in hand injuries.   Also, following all hand injuries, the rehabilitation is very important, and you want to be seen by an occupational therapist with experience in hand rehab.