Nail Bed Injuries

Any type of pinching, crushing, or sharp cut to the fingertip may result in injury to the nail bed.

Many result from crush injuries after getting the fingertip caught in a door machine.

How do they present to the hand surgeons?

1. Simple crushes very painful collection of blood (hematoma) under the nail.
2. More severe injuries –cracking of the nail into pieces, or tearing off of pieces of the nail and/or fingertip, and possible injuries to the adjacent structures.

What are the associated problems?

• Finger tip bone fracture- X-rays is recommended to find it.

Treatment of nail bed injuries:

• Straightforward cuts are repaired to put the parts back where they belong.
• Repairing the nail bed to bone fragments restores alignment of many fractures of the fingertip.
• Larger fragments of bone need pin/splinting to heal the fracture.
• Missing areas of nail bed can be grafted from the same finger or from other digits.

Prognosis:

The final appearance and function of the nail and surrounding structures depends on the ability to restore the normal anatomy and it takes 3-6 months for the nail to grow back.

www.rajagiriworld.com

[IMG]http://www.rajagiriworld.com/happy.gif[/IMG]

Nail avulsion

A toenail or fingernail that’s knocked loose is called a nail avulsion.

When does it happen?

A fingernail can be torn off when it catches on something.

• falling forward
• holding your ungloved fingers during work with the machines.
• direct blow,
• bike accident

The fingernail ripped loose as the biker fell into the road. Note that the base of the fingernail is lying ON TOP of the cuticle skin.

What are the problems?

• there’s a cut over the nail bed (from where nail develops)
• severe pain (exposed tissue can be quite sensitive)
• the finger or toe is crooked
• Infection can result if the area isn’t kept clean

What to do?

Immediately meet the Hand and Micro surgeon.

What does the doctor do?

Under suitable anesthesia,
• Loose nail is removed.
• Underlying nail bed (from where the nail originally forms) repair will be done.
• Clean away blood and debris
• Apply antibiotic ointment
• Dressing and immobilization

What is the prognosis?

The final appearance and function of the nail and surrounding structures can be restored to the normal as before.

How long it takes for the nail to grow after repair?

It normally takes 3-6 months for the nail to grow from the cuticle to the tip of the finger.

What happens if you have no treatment?
• Infection
• Severe pain
• Poor/absent nail with deformity.

It’s a roll of the dice. You may luck out and wind up with a pretty fair result. However, if the injury really needs surgery it’s best to do it right way.

www.rajagiriworld.com

[IMG]http://www.rajagiriworld.com/happy.gif[/IMG]