Monday, August 9, 2021

Nailbed Injuries

emDocs - August 09, 2021 - By Erik Sherman and Chen He
Reviewed by: Edward Lew; Alex Kaufman; Brit Long
Clinical Pearls:
  • For all nailbed injuries, perform a thorough exam to assess neurovascular status and identify involved tissue, and obtain an X-ray to rule out underlying phalanx fractures.
  • Consider trephination alone instead of nail removal – even for large subungual hematomas – so long as the nail fold edges are intact and there is no underlying displaced phalanx fracture.
  • Lacerations to the nailbed can be repaired effectively with similar outcomes using either absorbable sutures or tissue adhesive.
  • Replacement of the nail or use of another material to splint the nail fold after repair remains controversial, and ongoing studies hope to provide a clearer management plan.
  • Antibiotic prophylaxis is not generally indicated in patients with nailbed trauma with simple open distal phalanx fractures (of note: controversial).