Nailbed Injuries Follow-up

  • Author: Darrell Sutijono, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 7, 2010
 

Further Outpatient Care

  • In general, except for a simple subungual hematoma in which the nailbed was not inspected for potential laceration or injury, a wound check in 2-5 days is suggested to check for infection and to repack the nail fold, if necessary.
  • Sutures should be removed from any replaced nail in approximately 2-3 weeks.
  • If acrylic nail, hypodermic syringe sheath, or other material was used as a stent, it should be removed in 3 weeks.
  • If the original nail was used as a splint, it will be pushed out as new nail grows in, and it will fall out on its own.
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Inpatient & Outpatient Medications

The prophylactic use of antibiotics is indicated, depending on mechanism and extent of injury, such as for crush injuries and human bites or animal bites. Although the benefit of prophylactic antibiotics has not been proven, even if an open fracture of the distal phalanx is present, to be safe, many clinicians still prescribe a first-generation cephalosporin when bone or joint is exposed below a nailbed injury. A large, randomized controlled study may be necessary in the near future to examine the utility of antibiotics in such circumstances.

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Complications

Complications of nailbed injuries may include the following:

  • Scarring
  • Loss or obstruction of the nailfold
  • Destruction of nail with lack of new nail growth
  • Abnormal nail growth or disrupted nail growth
  • Infection
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Prognosis

  • Nailbed injuries generally heal well with appropriate treatment, although it may take months to years for the nail to grow back into the proper shape.
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Patient Education

  • All patients should be advised that a deformed nail is a possibility.
  • New nail growth may take from 3-12 months and even then, it may be misshapen for a longer time.
  • If problems with new nail growth exist at 6 or 12 months, patients may want to follow up with a hand surgeon for possible scar excision or nailbed revisions.
  • For excellent patient education resources, visit eMedicine's Skin, Hair, and Nails Center. Also, see eMedicine's patient education article Subungual Hematoma (Bleeding Under Nail).
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Contributor Information and Disclosures
Author

Darrell Sutijono, MD  Clinical Instructor, Department of Emergency Medicine, Yale University School of Medicine

Darrell Sutijono, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Institute of Ultrasound in Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, FACEP, MMB  Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate College of Medicine; Consulting Staff, Department of Emergency Medicine, Staten Island University Hospital, Kings County Hospital, University Hospital, State University of New York Downstate at Brooklyn

Mark A Silverberg, MD, FACEP, MMB is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Eric M Kardon, MD, FACEP  Attending Emergency Physician, Georgia Emergency Medicine Specialists; Physician, Division of Emergency Medicine, Athens Regional Medical Center

Eric M Kardon, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Tom Scaletta, MD  Chairperson, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Zook EG. Anatomy and physiology of the perionychium. Hand Clin. Feb 1990;6(1):1-7. [Medline].

  2. Brown RE. Acute nail bed injuries. Hand Clin. Nov 2002;18(4):561-75. [Medline].

  3. Zook EG. Understanding the perionychium. J Hand Ther. Oct-Dec 2000;13(4):269-75. [Medline].

  4. Inglefield CJ, D'Arcangelo M, Kolhe PS. Injuries to the nail bed in childhood. J Hand Surg [Br]. Apr 1995;20(2):258-61. [Medline].

  5. de Alwis W. Fingertip Injuries. Emerg Med Australas. Jun 2006;18(3):229-37. [Medline].

  6. Guy RJ. The etiologies and mechanisms of nail bed injuries. Hand Clin. Feb 1990;6(1):9-19; discussion 21. [Medline].

  7. Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg [Am]. Nov 1999;24(6):1166-70. [Medline].

  8. Meek S, White M. Subungual haematomas: is simple trephining enough?. J Accid Emerg Med. Jul 1998;15(4):269-71. [Medline].

  9. Seaberg DC, Angelos WJ, Paris PM. Treatment of subungual hematomas with nail trephination: a prospective study. Am J Emerg Med. May 1991;9(3):209-10. [Medline].

  10. Kaya TI, Tursen U, Baz K, Ikizoglu G. Extra-Fine Insulin Syringe Needle: An Excellent Instrument for the Evacuation of Subungual Hematoma. Dermatol Surg. Nov 2003;29(11):1141-3. [Medline].

  11. Harrison BP, Hilliard MW. Emergency department evaluation and treatment of hand injuries. Emerg Med Clin North Am. Nov 1999;17(4):793-822. [Medline].

  12. Jeys LM, Khafagy R. A useful technique for securing nails: the figure-of-eight suture. Br J Plast Surg. Oct 2001;54(7):651. [Medline].

  13. Richards AM, Crick A, Cole RP. A novel method of securing the nail following nail bed repair. Plast Reconstr Surg. Jun 1999;103(7):1983-5. [Medline].

  14. Hallock GG, Lutz DA. Octyl-2-Cyanoacrylate adhesive for rapid nail plate restoration. J Hand Surg [Am]. Sep 2000;25(5):979-81. [Medline].

  15. Hallock GG. Expanded applications for octyl-2-cyanoacrylate as a tissue adhesive. Ann Plast Surg. Feb 2001;46(2):185-9. [Medline].

  16. Strauss EJ, Weil WM, Jordan C, Paksima N. A Prospective, Randomized Controlled Trial of 2-Octylcyanoacrylate Versus Suture Repair for Nail Bed Injuries. J Hand Surg [Am]. Feb 2008;33(2):250-3. [Medline].

  17. Pasapula C, Strick M. The use of chloramphenicol ointment as an adhesive for replacement of the nailplate after simple nail bed repairs. J Hand Surg [Br]. Dec 2004;29(6):634-5. [Medline].

  18. Purcell EM, Hussain M, McCann J. Fashionable splint for nailbed lacerations: the acrylic nail. Plast Reconstr Surg. Jul 2003;112(1):337-8. [Medline].

  19. Etoz A, Kahraman A, Ozgenel Y. Nail bed secured with a syringe splint. Plast Reconstr Surg. Nov 2004;114(6):1682-3. [Medline].

  20. Bayraktar A, Ozcan M. A nasogastric catheter splint for a nailbed. Ann Plast Surg. Jul 2006;57(1):120. [Medline].

  21. Abbase EH, Tadjalli HE, Shenaq SM. Fingertip and nail bed injuries. Repair techniques for optimum outcome. Postgrad Med. Nov 1995;98(5):217-9, 223-4, 230 passim. [Medline].

  22. Chudnofsky CR, Sebastian S. Special wounds. Nail bed, plantar puncture, and cartilage. Emerg Med Clin North Am. Nov 1992;10(4):801-22. [Medline].

  23. Hart RG, Kleinert HE. Fingertip and nail bed injuries. Emerg Med Clin North Am. Aug 1993;11(3):755-65. [Medline].

  24. Melone CP Jr, Grad JB. Primary care of fingernail injuries. Emerg Med Clin North Am. May 1985;3(2):255-61. [Medline].

  25. Shepard GH. Management of acute nail bed avulsions. Hand Clin. Feb 1990;6(1):39-56; discussion 57-8. [Medline].

  26. Stevenson TR. Fingertip and nailbed injuries. Orthop Clin North Am. Jan 1992;23(1):149-59. [Medline].

  27. Van Beek AL, Kassan MA, Adson MH, Dale V. Management of acute fingernail injuries. Hand Clin. Feb 1990;6(1):23-35; discussion 37-8. [Medline].

 
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Trephination of a subungual hematoma.
Nailbed repair.
 
 
 
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