Which clinical history findings are characteristic of nailbed injuries?

Updated: Sep 27, 2017
  • Author: Darrell Sutijono, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Answer

A complete history for a nailbed injury should include hand dominance, time of the injury, the presence of an associated open wound, previous history of hand injury, tetanus status, occupation and hobbies, and the patient's overall health. All of these aspects of the patient's presentation may affect the treatment plan for the injury. Also, inquire about the circumstances of the accident, as the mechanism of injury has prognostic implications for severity of injury and wound contamination.

Most injuries of the nailbed involve the fingertip versus an isolated nailbed injury (6:1 ratio). The right and left hands are affected equally. However, the long finger is most often affected, since it is usually the last to be pulled from a situation that has the potential to cause trauma. After the long finger, the ring, index, pinky, and thumb are affected in that order. The middle and distal third of the nail are the most frequent sites of injury.

Crush and avulsion injuries as well as injuries associated with distal phalanx fractures have a worse prognosis. Injuries that span the entire nailbed or most of the bed and fold also fare worse than those that are isolated to one to two thirds of the nailbed or only to the nail fold and germinal matrix.


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