Nailbed laceration

Background
  • Results from a crush injury or blunt trauma

Nailtip Anatomy
A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin.
  • The perinychium includes the nail, the nailbed, and the surrounding tissue.
  • The paronychia is the lateral nail folds
  • 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
  • Laceration of the nail bed
  • May also include nail avulsion and/or distal phalanx fracture

Differential Diagnosis

Distal Finger (Including Nail) Injury

Evaluation
  • Plain films of the involved digits to evaluate for fracture

Management
  • Remove overlying nail, if present
  • Repair lacerations using 5-0 or 6-0 absorbable sutures
  • Replace nail into nail fold
    • Trephination of the nail may be performed to allow drainage of blood
    • Nail may be sutured into place
    • Alternatively, a nail-shaped adaptic or non-adherent gauze may be placed under the nail fold

Prognosis
  • Complete nail regrowth may take 70 to 160 days
  • Potential risk of nail deformity and losing the nail

Disposition
  • Discharge


See Also
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