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

• Laceration of the nail bed
• May also include nail avulsion and/or 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

Evaluation

• Plain films of the involved digits to evaluate for fracture

Management

• Remove overlying nail, if present
• Repair lacerations using 5-0 or 6-0 absorbable sutures
• Replace nail into nail fold
  • Trephination of the nail may be performed to allow drainage of blood
  • Nail may be sutured into place
  • Alternatively, a nail-shaped adaptic or non-adherent gauze may be placed under the nail fold

Prognosis

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

Disposition

• Discharge

See Also

• Subungal Hematoma