Approach to nail trauma for primary care physicians

Abstract

ObjectiveTo provide an overview and approach to common nail bed injuries seen by primary care practitioners. Sources of informationAn Ovid MEDLINE literature search was performed using search terms and studies were graded based on level of evidence.Main message Nail trauma is common in primary care practice and requires proper and prompt treatment to avoid lasting effects on finger function and cosmesis. When presented with a fingernail injury, primary care physicians should perform a thorough physical examination to determine extent of injury; take a history to rule out notable risk factors; perform a comprehensive neurovascular examination to assess pulp capillary refill, to do a 2-point discrimination, and to compare with an uninjured digit; and evaluate range of motion. Clinical evaluation may require local anesthesia and a tourniquet. Nail bed trauma can present in different ways and includes subungual hematomas, distal phalanx fractures, Seymour fractures, and-in more severe casesfragmentation or avulsion of the nail bed. Treatment for subungual hematomas where the nail plate is intact does not require nail plate removal and nail bed exploration; however, exploration and repair are indicated for a nail plate injury, a proximal fracture involving the germinal matrix, and a distal phalanx fracture requiring stabilization. ConclusionFingertips are essential to normal hand function. Nail trauma is common and can be managed by primary care physicians. Shared decision making concerning management is based on the mechanism and extent of the injury and aims to prevent secondary deformities.This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to https://www.cfp.ca and click on the Mainpro+ link. This article has been peer reviewed.

Kuduz Riskli Hayvan Teması Olan Hastaların Değerlendirilmesi

“…Bizim çalışmamızda yaranın derinliği, hayvanın türü, hayvanın sahipli olup olmaması, hastaların kırsal alanda yaşaması, hastaların yaşı ve cinsiyetinin hastaneye ilk 24 saat içine başvurma durumunu etkilemediği görülmüştür. Kuduz riskli temas durumunda erken dönemde lokal yara tedavisinin yapılması, ısırılan bölgenin su ve sabunla derhal yıkanması kuduzdan korunmada en etkili yöntemdir (14).…”