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Nail Bed Injuries
Injuries to the
nail are often associated with damage to other structures that are in
the same location. These include fractures of the bone (distal phalanx),
and/or cuts of the nailbed, fingertip skin (pulp), tendons that straighten
or bend the fingertip, and nerve endings.
Many result from crush injuries
after getting the fingertip caught in a door. Any type of pinching, crushing,
or sharp cut to the fingertip may result in injury to the nail bed.
Simple crushes of the
fingertip may result in a very painful collection of blood (hematoma)
under the nail. More severe injuries can result in cracking of the nail
into pieces, or tearing off of pieces of the nail and/or fingertip, and
possible injuries to the adjacent structures.
An accurate history of the
cause of the injury should be obtained. X-rays are recommended to look
for associated fractures that may require treatment. The full extent
of the injury may not be evident until adequate anesthesia (usually local)
is given and the nail is examined with magnification. Other medical conditions
that may affect healing should be discussed with your physician.
Restoring the normal anatomy
of the nail and surrounding structures is the goal of treatment. Simple
hematomas are drained by making a small hole in the nail in order to
relieve the pressure and provide pain relief. Straightforward cuts are
repaired to put the parts back where they belong.Repairing the nail bed
to which the fragments of bone are attached usually restores alignment
of many fractures of the fingertip. Larger fragments of bone may need
to be pinned or require splinting to heal the fracture. Missing areas
of nail bed can be grafted from the same finger or from other digits.
Tendon injury may require splinting or pinning. Local flaps of skin may
be used to replace missing skin, or the open area of skin may be allowed
to just heal on its own, or covered with a skin graft.
The final appearance and function of the nail
and surrounding structures depends on the ability to restore the normal
anatomy. If the injury is sharp and can be repaired, a normal nail is
likely. If there is more severe crushing of the nail bed, then there
is a greater likelihood of nail bed scarring and subsequent deformity
of the nail. If the germinal matrix (crescent-shaped zone at the base
of the nail bed from which the nail grows) is injured, there will likely
be a deformity of the nail as it grows. The function of the fingertip
also depends on the extent of injury to structures other than the nail.
It normally takes 3-6 months for the nail to grow from the cuticle to
the tip of the finger.
Loss of part or all of the nail
bed can be reconstructed with grafts from other digits. Grafts may be
taken from the nail bed of a toe to prevent further injury or deformity
of the fingers. The most common graft is a split-thickness graft to reconstruct
missing nail bed.
The anatomy of the nail
bed and surrounding structures.
The anatomy of the nail bed and surrounding structures from
a lateral view.
© 2007 American Society for Surgery of the Hand
Developed by the ASSH Public Education Committee
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