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Nailbed Injuries Follow-up

  • Author: Darrell Sutijono, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Mar 24, 2016
 

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 eMedicineHealth's Skin Conditions and Beauty Center. Also, see eMedicineHealth's patient education article Subungual Hematoma (Bleeding Under Nail).

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Contributor Information and Disclosures
Author

Darrell Sutijono, MD Attending Physician, Department of Emergency Medicine, Kaiser Permanente Santa Clara Medical Center

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

Disclosure: Nothing to disclose.

Coauthor(s)

Mark A Silverberg, MD, MMB, FACEP Assistant Professor, Associate 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 Medical Center

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

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, American Medical Informatics Association, Medical Association of Georgia

Disclosure: Nothing to disclose.

Acknowledgements

Tom Scaletta, MD President, Smart-ER (http://smart-er.net); Chair, 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.

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Trephination of a subungual hematoma.
Nailbed repair.
 
 
 
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