Nail Bed Injuries

These are the most common hand injuries seen in hospital emergency departments.

What is it?

Associated conditions are fractures, dislocations, tendon and nerve injuries to the finger-tip

Causes

Nail bed injuries are the result of direct trauma to the fingertips.

  • Subungual hematoma – crush injuries which cause bleeding under the nail.
  • Nail bed lacerations – saw injuries /direct blows to the nail
  • Nail bed avulsions- high energy injuries.

Treatment

  • Drainage of haematoma by small drainage hole into the nail to relieve pressure and provide pain relief
  • Removal of nail, incision and drainage and nailbed repair.
  • Fracture fixation by pinning or splinting.
  • Split thickness graft for loss of part or all of the nail bed
  • Tendon injury management by splinting.

What to do?

  • Splinting for protection while nail/graft/tendon/fracture is healing
  • Management of scarring
  • Desensitisation

Final appearance and function depends on the ability to restore the normal anatomy and the extent of the injury. More severe crushing will cause more nail bed scarring and deformity of the nail. Further surgical management may be required for hook nails and split nails.

The fingernail is the armour for the sensitive and vulnerable fingertip and for it to function normally it must protrude 1-2 mm beyond the edge of the finger; otherwise it cannot be used to pick up small objects (needles, pins) that require hooking with the free edge of the nail.

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