Nailbed laceration
Revision as of 18:57, 25 February 2018 by Rossdonaldson1 (talk | contribs)
Background
- Results from a crush injury or blunt trauma
Nailtip Anatomy
- 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