Nail avulsion

Revision as of 19:27, 25 February 2018 by Rossdonaldson1 (talk | contribs) (Differential Diagnosis)

Background

  • Generally results from blunt trauma
A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin.

Clinical Features

  • Nail completely or partial removed from nailbed
  • May present with concomitant nailbed laceration

Differential Diagnosis

Distal Finger (Including Nail) Injury

Hand and finger injuries

Evaluation

  • Clinical diagnosis
  • Obtain xray to check for fracture, dislocation, and foreign body
  • Detailed neurovascular exam noting sensation and capillary refill

Management

  • For partial avulsion, gently lift nail but do not remove to inspect nail bed for laceration
  • For complete avulsion:
    • Repair any nailbed laceration
    • Replace nail into nailfold after cleaning nail and suture into place
    • If no nail, place a non-adherent, petroleum containing gauze into nail fold. Can Also use aluminum wrapping of suture package as pseudo-nail to allow appropriate spacing for new nail to grow in. This should be left in place for 2-3 weeks.
    • Wound should be re-evaluated in 3-5 days and gauze replaced[1]

Disposition

  • Discharge

See Also

External Links

References

  1. Lammers, R.L. and Smith, Z.E. Chapter 35: Methods of Wound Closure. In: Roberts, J ed. Roberts and Hedges' Clinical Procedures in Emergency Medicine. Elsevier; 2014:644-689