What are nailbed injuries?

Updated: Sep 27, 2017
  • Author: Darrell Sutijono, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Nailbed injuries are common, with fingertip injuries being the most often seen type of hand injuries. The fingertip is frequently injured because it is the point of interaction between the body and one's surroundings in the majority of activities performed on a daily basis, and it is the most distal portion of the upper extremities. [1, 2, 3, 4, 5, 6]

In addition to long-term cosmetic consequences, injuries to the nail can affect daily living. The nail provides protection for the fingertip, offers the ability to pick up small objects, and plays a role in tactile sensation. It serves as a counter force when the finger pad touches an object; two-point discrimination distance widens substantially with removal of a nail.

Blunt trauma to the fingertip and nailbed requires adequate treatment to prevent secondary deformities and reduce the need for subsequent reconstruction. [7] Delayed or inadequate treatment can result in negative functional and cosmetic outcomes. Peak incidence of fingertip and nailbed injuries is from 4 to 30 years of age. According to Chang et al, 10% of such accidents are treated in the emergency department. In the case of fingertip injuries, the nailbed is injured in 15-24% of cases. [8]

The injured finger can usually be examined without anesthesia, although children or those in severe pain may require a digital block first. A complete examination of sensation (performed prior to a digital block), motor function, and vascular supply is necessary.

A digital block of 1% lidocaine hydrochloride without epinephrine provides anesthesia of sufficient duration for most repairs. Bupivacaine extends anesthesia time 4-8 hours for longer procedures. Children may require procedural sedation and analgesia.

Observe the posture of the fingers, and look for any presence of deformities signifying fracture, dislocation, or tendon avulsion, and the presence of glass, wood, metal, or other foreign body fragments.

Depending on the extent of injury, radiologic evaluation with anteroposterior, lateral, and oblique views of the injured finger(s) may be useful to rule out foreign bodies and fractures or dislocations of the distal finger. [6]

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