Thanks to Dr. Wang for presenting today’s Morning Report!

 

Nailbed Injuries

 

  • Typically caused by crush injuries with hammer, in doorway, or car doors. Trauma by saws, knives, or drills can also cause these injuries
    • Subungual hematoma: 50% have underlying nailbed laceration
    • Nailbed injuries: nailbed lacerations

 

  • Workup includes xrays to rule out fracture. 50% of nailbed injuries have associated fractures

 

  • Repair
    • Subungual hematoma: trephination

 

  • Nail plate avulsion
    • Digitally block with 1% lidocaine without epi
    • Tourniquet the finger for blood-free field
    • Remove nail: elevate/separate nailplate from nailbed with iris or fine scissors. DO NOT cause further damage to nail bed. Use hemostat gently remove nail.
    • Nailbed laceration is repaired with 6-0 absorbable sutures
    • Use native nail (if you can) as a stent to keep the nail fold open for new nail growth
    • Use aluminum suture packing as splint if native nail not available
    • Place native nail or splint into the nail fold and suture in place with 5-0 or smaller nylon
      • Distally through the hyponychium and nail
      • Through paronychia and nail bilaterally
      • Through the nail and proximal nail fold
      • Horizontal mattress through proximal nail fold
      • Dorsal figure of eight suture (spork method)
    • Dermabond can be used
    • Dress with non-adherent gauze

 

  • Consult hand if significant avulsed matrix or severe crush injury
  • Tetanus, Pain control
  • Follow up in 2-3 days for wound check. Sutures to be removed after 2-3 weeks.
The following two tabs change content below.

Jay Khadpe MD

  • Editor in Chief of "The Original Kings of County"
  • Assistant Professor of Emergency Medicine
  • Assistant Residency Director
  • SUNY Downstate / Kings County Hospital

Latest posts by Jay Khadpe MD (see all)


Jay Khadpe MD

  • Editor in Chief of “The Original Kings of County”
  • Assistant Professor of Emergency Medicine
  • Assistant Residency Director
  • SUNY Downstate / Kings County Hospital

0 Comments

Leave a Reply

Avatar placeholder

Your email address will not be published. Required fields are marked *

%d bloggers like this: