Management of Simple Nail Bed Lacerations and Subungual Hematomas in the Emergency Department

Abstract

Fingertip crush injuries are common hand injuries in children and often are evaluated initially in an emergency department. Nail bed injuries can be classified into subungual hematomas, simple or stellate lacerations, crush injuries, and avulsions. Emergency department physicians with good knowledge of fingertip anatomy can appropriately manage these injuries so as to prevent long-term fingertip deformities and functional deficits. The management of simple nail bed lacerations and subungual hematomas has remained somewhat controversial with much debate surrounding the necessity of removing the nail plate for repair of a nail bed laceration versus trephination alone of a large subungual hematoma. This article will discuss the management and evaluation of simple nail bed injuries by emergency department physicians to prevent chronic nail and fingertip deformities.

Fingertip Injuries in Children: Epidemiology, Financial Burden, and Implications for Prevention

“…If fingertip injuries are not treated adequately, the patient can experience longterm tenderness, pain, stiffness, sensory problems, deformity in the nail, soft tissue irregularities, and decreased grip strength. 6 It has been well documented that optimal outcomes depend on high-quality care from ED physicians who are well trained in diagnosing and managing fingertip injuries, 4,14,15,18 and who are prepared to refer complicated cases to a pediatric hand surgeon. 6,14 Outcomes depend in part on quality surgical care, and it is estimated that about 10% of all pediatric fingertip injury patients require surgery with general anesthesia.…”

“…6 It has been well documented that optimal outcomes depend on high-quality care from ED physicians who are well trained in diagnosing and managing fingertip injuries, 4,14,15,18 and who are prepared to refer complicated cases to a pediatric hand surgeon. 6,14 Outcomes depend in part on quality surgical care, and it is estimated that about 10% of all pediatric fingertip injury patients require surgery with general anesthesia. 13 In our study, patients most commonly presented with a fracture, and 25% of all patients required surgical intervention; 10% received immediate surgery.…”

Simple Approach. Beautiful Outcome in Nail Bed Repair in Pediatric Patients

“…The skin was sutured first, with 5-0 rapide vicryl suture • then the nail bed, meticulously with 6-0 vicryl sutures with round body needle in an interrupted fashion, under 4 x loupe magnification [3,4].…”

Nail Trauma

“…Fingertip injuries account for 15-24% of all hand injuries, particularly affecting the 4-30-year-old age group [1].…”