Jump to content
We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Nail Bed Lacerations

From WikiSM
(Redirected from Nailbed Injury)


Other Names

  • Nailbed lac
  • Nailbed Laceration
  • Finger nail laceration
  • Toe nail laceration
  • Nailbed avulsion

Background

History

Epidemiology

  • Pediatrics
    • Account for 15-24% of fingertip injuries[1]

Pathophysiology

Illustration of the fingernail anatomy[2]
Left: Nailbed laceration with partial avulsion of the finger nail. Right: the nailbed has been repaired.[3]
  • General
    • Laceration to nail bed often associated with other injuries
    • May involve only nail, frequently involves nail bed as well
    • Due to direct trauma (i.e. crush, cutting, etc)
  • Types
    • Simple lacerations
    • Stellate lacerations
    • Crush injuries

Associated Conditions

Pathoanatomy

  • Nail Bed Anatomy and terminology
    • Perionychium: includes the nail, nailbed, and surrounding skin
    • Paronychium: includes the lateral nail folds
    • Hyponychium: skin distal and palmar to the nail
    • Eponychium: includes the dorsal nail fold and proximal to nail fold
    • Lunula: white part of the proximal nail

Risk Factors

  • Unknown

Differential Diagnosis

Differential Diagnosis Hand Pain

Differential Diagnosis Foot Pain

Clinical Features

  • History
    • The patient will describe some form of trauma
    • Patient will endorse pain, swelling, bleeding, deformity
    • Their pay may limit full extension of the affected digit
    • Important to clarify hand dominance, occupation, hobbies, etc
  • Physical Exam: Physical Examination Hand or Physical Exam Foot
    • The patient will have laceration to nail bed, frequently with active bleeding
    • Other soft tissue or osseus injuries may also be apparent
    • Important to document that flexion and extension of the digit are intact

Evaluation

Classification

  • Simple: No bony injury
  • Complex: Involves fracture

Management

Nonoperative

  • Indications
    • Most cases
  • Digital Nerve Block
    • Should be utilized for all procedures
  • Exploration for lacerations
    • In the presence of a subungual hematoma >50% of the nail, some physicians recommend removing the nail and exploring for lacerations
      • This is controversial and likely unnecessary
    • In the presence of partially avulsed nail plate that remains attached to nail matrix, removal is probably not necessary
  • Procedure: Nail Bed Repair
    • Remove the nail plate, evaluate for nail bed injuries and do a primary repair with sutures
    • Remove the nail plate, evaluate for nail bed injuries, suture an artificial spacer under the eponychial fold
    • Do nothing may be an option if the injury is small enough with healing by secondary intention
    • Consider use of medical adhesive to repair nail bed
  • Adhesive Glue Technique
    • Brands include dermabond,
    • Advantages: speed of repair
    • Likely appropriate, effective for smaller or simple lacerations[5]
  • Tetanus Booster
    • Provide as indicated
  • Antibiotic Prophylaxis
    • Indicated depending on mechanism of injury
    • Animal and human bites: Augmentin or non-penicillin alternative
    • Crush injuries: 1st gen cephalosporin
    • “Open fractures”, i.e. associated tuft fracture with nailbed injury: 1st gen cephalosporin
      • Note that this is somewhat controversial but still commonly practiced
      • Metcalf et al: no difference in infection rate, osteomyelitis between prophylaxis group and no prophylaxis[6]

Operative

  • Consider consultation if
    • Fingertip amputations
    • Phalanx fractures that are displaced or complicated
    • Injuries with significant damage to the nail fold
  • Indications
    • Unknown

Rehab and Return to Play

Rehabilitation

  • No clear guidelines

Return to Play/ Work

  • No clear guidelines

Complications and Prognosis

Prognosis

  • Unknown

Complications

See Also

External

References

  1. ↑ Al-Qadhi S, Chan KJ, Fong G, et al. Management of uncomplicated nail bed lacerations presenting to a children's emergency department. Pediatr Emerg Care. 2011;27:379–383.
  2. ↑ Patel L. Management of Simple Nail Bed Lacerations and Subungual Hematomas in the Emergency Department. Pediatric Emergency Care. 2014; 30 (10): 742-745. doi: 10.1097/PEC.0000000000000241.
  3. ↑ Veganzones, Rebeca Astorga. "Nail Trauma." Emergency Medicine and Trauma. IntechOpen, 2019.
  4. ↑ George A, Alexander R, Manju C. Management of Nail Bed Injuries Associated with Fingertip Injuries. Indian J Orthop. 2017;51(6):709-713. doi:10.4103/ortho.IJOrtho_231_16
  5. ↑ Edwards, Sarah, and Leesa Parkinson. "Is fixing pediatric nail bed injuries with medical adhesives as effective as suturing?: a review of the literature." Pediatric emergency care 35.1 (2019): 75-77.
  6. ↑ Metcalfe D, Aquilina AL, Hedley HM. Prophylactic antibiotics in open distal phalanx fractures: systematic review and meta-analysis. J Hand Surg Eur Vol. 2016;41(4):423-430. doi:10.1177/1753193415601055
Created by:
John Kiel on 1 September 2019 22:25:46
Authors:
Last edited:
20 August 2025 23:05:24
Categories:
Lower Extremity | Trauma | Finger | Foot | Upper Extremity | Acute
Retrieved from "https://wikism.org/w/index.php?title=Nail_Bed_Lacerations&oldid=36671"