Nail avulsion

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Background

  • Can be complete or partial
  • Result from blunt trauma


Clinical Features

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

Differential Diagnosis

Diagnosis

  • Obtain hand xray to check for fracture, dislocation, and foreign body
  • Detailed neurovascular exam of hand 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 nailfold.

Disposition

  • Keep nail splint or gauze in place for 2-3 weeks
  • Re-eval wound in 3-5 days and if gauze was placed in nailfold replace with new gauze[1]

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