Nailbed laceration

Background

• Results from a crush injury or blunt trauma

Nailtip Anatomy

A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin.

• The perionychium includes the nail bed and the paronychium.
• The paronychium is the lateral nail fold (soft tissue lateral to the nail bed).
• The hyponychium is the palmar surface skin distal to the nail.
• The lunula is that white semi-moon shaped proximal portion of the nail.
• The sterile matrix is deep to the nail, adheres to it and is distal to the lunule.
• The germinal portion is proximal to the matrix and is responsible for nail growth.

Clinical Features

• May include one or more of the following:
  • Nail avulsion (partial or complete)
  • Nailbed laceration
  • Distal phalanx fracture

Differential Diagnosis

Distal Finger (Including Nail) Injury

• Distal interphalangeal dislocation (finger)
• Distal phalanx (finger) fracture
• Finger amputation
• Fingertip avulsion
• Finger infection
• Nailbed laceration
• Nail avulsion
• Subungual hematoma

Workup

• Obtain xrays of the involved digits if there is suspicion for fracture

Management

• Repair simple lacerations using 5-0 or 6-0 absorbable sutures
• Trephination should be performed to allow drainage of blood after the nail is reinserted into the nail fold
• The nail may be sutured in place through the trephinated hole(s) or taped in place
• A nail-shaped adaptic or non-adherent gauze may be placed under the nail fold if the original nail is misplaced or unusable

Prognosis

• Complete nail growth may take 70 to 160 days
• Potential risk of nail deformity and losing the nail

See Also

• Subungal Hematoma