Which of the following injuries DOES NOT require immediate transfer for urgent operative treatment?
A. Open tuft (distal phalanx) fracture of the right index finger of a right-hand dominant man.
B. Small, nonbleeding puncture wound to left index finger of a right-hand dominant mechanic who was injured when testing a high-pressure paint gun.
C. 1 cm laceration overlying the dorsal right third MCP joint that was sustained when the patient punched someone else in the face.
D. All of the above injuries require immediate patient transfer for specialty evaluation and operative washout.
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Answer: A. Open tuft fractures can be managed in the UC setting with local wound care to include copious irrigation, wound closure, and prompt outpatient follow up. Although frequently prescribed in these cases, studies have not shown that antibiotics carry any benefit unless complicating features are present. The other 2 injuries listed carry significant risk of morbidity and loss of hand function unless early operative intervention is undertaken.