Nail Bed Injury

Fehrenbacher, Victor; Blackburn, Ethan

doi:10.1016/j.jhsa.2014.10.024

Cited by 12 publications

(9 citation statements)

References 11 publications

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“…Nail plate removal is encouraged in instances of fractures involving injury to the germinal matrix, laceration with injury to the nail plate or bed, or displaced distal phalanx fractures treated with pinning. 5 In this case, nail plate removal revealed a 4-mm ulnar-side nail bed injury that was repaired. No antibiotics were prescribed because evidence has shown that aggressive débridement and wound irrigation in finger fractures has minimal risk of infection.…”

Section: Distal Phalanx Tuft Fracturementioning

confidence: 78%

“…When a subungual hematoma is present, decompression may be performed by means of trephination or nail plate removal for symptomatic relief and to repair the nail bed injury. 4,5 Current evidence does not support trephination over plate removal for decompression. It is not necessary to remove the nail plate if the patient is asymptomatic and if the nail is adherent to the nail bed.…”

Section: Treatment Strategiesmentioning

confidence: 99%

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An Evidence-Based Guide for Managing Phalangeal Fractures

Kumar

Chung

2021

Plastic &Amp; Reconstructive Surgery

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halangeal fractures make up a quarter of hand and forearm fractures and are the second most common fracture of the upper extremity after distal radius and ulna fractures. 1,2 The highest incidence (21 percent) of phalangeal fractures occur in children aged 5 to 14 years and, overall, they are the most prevalent type of fracture in male patients. The most common mechanism of injury among pediatric patients is a crush injury during sport, whereas among adult patients, work-related injuries are the most common. 3 The distal phalanx is the most commonly fractured phalanx.Fractures of the phalanges are described according to the anatomical location (i.e., proximal, middle, or distal), fracture pattern (i.e., transverse, oblique, spiral, comminuted, or impacted), degree of displacement (i.e., none, minimal, or displaced), and articular involvement (i.e., none, unicondylar, or bicondylar). The initial workup of such fractures should involve three-view radiographs of the hand and dedicated radiographic views of the injured finger if needed. The decision for additional imaging modalities such as magnetic resonance imaging or ultrasound (for soft-tissue injury) or computed tomographic scan (for occult bony fractures) should be made based on clinical suspicion for concomitant injuries.These fracture characteristics are considered with associated injuries (e.g., open wounds, nail bed injuries, other fracture sites) and amount of soft-tissue loss to determine fracture stability and guide treatment strategies. Treatment options for phalangeal fractures encompass splinting or buddy taping with or without closed reduction, and operative treatment by percutaneous and open techniques. Operative indications for phalangeal fractures are listed in Table 1.This article will use a case-based approach to describe the steps involved in evaluating a phalangeal fracture and use an evidence-based approach to develop a treatment strategy. The principles in workup and treatment for each fractured digit are applicable to other digits sustaining similar fracture patterns. DISTAL PHALANX TUFT FRACTURE Representative CaseCase 1 An 11-year-old presents with a thumb crush injury involving a door. There is a subungual hematoma of

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Section: Distal Phalanx Tuft Fracturementioning

confidence: 78%

Section: Treatment Strategiesmentioning

confidence: 99%

An Evidence-Based Guide for Managing Phalangeal Fractures

Kumar

Chung

2021

Plastic &Amp; Reconstructive Surgery

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“…Several other studies and guidelines support trephination alone for subungual hematoma of any size when the nail plate is adherent to the nail bed, without any appreciable nail lacerations (level II evidence). [8][9][10][11] Note that 50% of nail bed injuries have an accompanying DP fracture. 5 Nondisplaced fractures are managed expectantly, while tuft and nondisplaced DP fractures may require nail bed repair and nail plate splinting.…”

Section: Main Messagementioning

confidence: 99%

“…For subungual hematomas, nail plate removal and nail bed exploration are not indicated with an intact nail plate and distal edge (level II evidence). [7][8][9][10][11] However, exploration and repair are indicated for any associated nail plate injury, a proximal fracture involving the germinal matrix, and DP fracture requiring stabilization (level III evidence). 8,14 Before attempting nail plate removal, administer local anesthetic and apply a tourniquet.…”

Section: Main Messagementioning

confidence: 99%

“…[7][8][9][10][11] However, exploration and repair are indicated for any associated nail plate injury, a proximal fracture involving the germinal matrix, and DP fracture requiring stabilization (level III evidence). 8,14 Before attempting nail plate removal, administer local anesthetic and apply a tourniquet. For removal, enter the hyponychium with curved scissors (concave side down), and gently release the nail by repeatedly spreading the scissors, staying just under the plate, until the lateral margins and eponychium are reached.…”

Section: Main Messagementioning

confidence: 99%

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Approach to nail trauma for primary care physicians

Lafreniere,

Misati,

Knox

2023

Can Fam Physician

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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.

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Nagelluxatiea

Spruit¹

2017

Kleine Kwalen Bij Kinderen

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Nail Bed Injury

Cited by 12 publications

References 11 publications

An Evidence-Based Guide for Managing Phalangeal Fractures

An Evidence-Based Guide for Managing Phalangeal Fractures

Approach to nail trauma for primary care physicians

Nagelluxatiea

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