Nailbed Injuries Medication
- Author: Darrell Sutijono, MD; Chief Editor: Trevor John Mills, MD, MPH more...
The goal of pharmacotherapy is to reduce pain and to prevent infection. If not updated, tetanus immunization is indicated.
Therapy must cover all likely pathogens in the context of the clinical setting. The prophylactic use of antibiotics is indicated depending on mechanism and extent of injury, such as for crush injuries and human 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 are 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.
First-generation cephalosporin that inhibits bacterial growth by inhibiting bacterial cell wall synthesis. Bactericidal and effective against rapidly growing organisms forming cell walls. Acceptable alternative to penicillin and may be useful in patients with minor penicillin allergies.
Nonsteroidal anti-inflammatory agents (NSAIDs)
NSAIDs are commonly used for relief of mild to moderate pain. Effects of NSAIDs in treating pain tend to be patient specific, but ibuprofen is usually the drug of choice (DOC) for initial therapy. Other options include ketoprofen, flurbiprofen, and naproxen.
Usually DOC for treatment of mild to moderate pain if no contraindications exist. Decreases inflammatory reactions and pain by inhibiting the activity of the enzyme cyclooxygenase, resulting in diminished prostaglandin synthesis.
Has analgesic, antipyretic, and anti-inflammatory effects. Decreases inflammatory reactions and pain by inhibiting the activity of the enzyme cyclooxygenase, resulting in diminished prostaglandin synthesis.
Used for relief of mild to moderate pain and inflammation. For patients with a small body size, elderly persons, and those with renal or liver disease, initially administer small dosages. Doses >75 mg do not increase therapeutic effects. Administer high doses with caution and closely observe patients' responses.
Used for relief of mild to moderate pain. Decreases inflammatory reactions and pain by inhibiting the activity of the enzyme cyclooxygenase, resulting in diminished prostaglandin synthesis.
These agents are reserved for those with moderate to severe pain. They should be prescribed in the setting of those who have contraindications to NSAIDS, or for breakthrough pain while using NSAIDS. Current practice dictates a short course of use.
DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants.
Drug combination indicated for treatment of mild to moderate pain.
Drug combination indicated for the relief of moderate to severe pain.
Drug combination indicated for the relief of moderate to severe pain. DOC for aspirin-hypersensitive patients.
This agent is used for tetanus immunization. Administer booster injection in previously immunized individuals to prevent this potentially lethal syndrome.
Used to induce active immunity against tetanus in selected patients. The immunizing agent of choice for most adults and children aged > 7 y are tetanus and diphtheria toxoids. Necessary to administer booster doses to maintain tetanus immunity throughout life. Pregnant patients should receive only tetanus toxoid, not a diphtheria antigen-containing product. May administer into deltoid or midlateral thigh muscles in children and adults. In infants, preferred site of administration is the mid thigh laterally.
Patients who may not have been immunized against Clostridium tetani products should receive tetanus immune globulin (Hyper-Tet).
Used for passive immunization of persons with wounds that may be contaminated with tetanus spores.
Brown RE. Acute nail bed injuries. Hand Clin. 2002 Nov. 18(4):561-75. [Medline].
Inglefield CJ, D'Arcangelo M, Kolhe PS. Injuries to the nail bed in childhood. J Hand Surg [Br]. 1995 Apr. 20(2):258-61. [Medline].
de Alwis W. Fingertip Injuries. Emerg Med Australas. 2006 Jun. 18(3):229-37. [Medline].
Van Beek AL, Kassan MA, Adson MH, Dale V. Management of acute fingernail injuries. Hand Clin. 1990 Feb. 6(1):23-35; discussion 37-8. [Medline].
Loréa P. Primary care of nail traumas. Chir Main. 2013 Jun. 32 (3):129-35. [Medline].
Tully AS, Trayes KP, Studdiford JS. Evaluation of nail abnormalities. Am Fam Physician. 2012 Apr 15. 85 (8):779-87. [Medline].
Nanninga GL, de Leur K, van den Boom AL, de Vries MR, van Ginhoven TM. Case report of nail bed injury after blunt trauma; what lies beneath the nail?. Int J Surg Case Rep. 2015. 15:133-6. [Medline].
Chang J, Vernadakis AJ, McClellan WT. Fingertip injuries. Clin Occup Environ Med. 2006. 5 (2):413-22, ix. [Medline].
Zook EG. Anatomy and physiology of the perionychium. Hand Clin. 1990 Feb. 6(1):1-7. [Medline].
Zook EG. Understanding the perionychium. J Hand Ther. 2000 Oct-Dec. 13(4):269-75. [Medline].
Haneke E. Anatomy of the nail unit and the nail biopsy. Semin Cutan Med Surg. 2015 Jun. 34 (2):95-100. [Medline].
Guy RJ. The etiologies and mechanisms of nail bed injuries. Hand Clin. 1990 Feb. 6(1):9-19; discussion 21. [Medline].
Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg [Am]. 1999 Nov. 24(6):1166-70. [Medline].
Gaston RG, Chadderdon C. Phalangeal fractures: displaced/nondisplaced. Hand Clin. Aug 2012. 28(3):395-401. [Medline].
Simon RR, Wolgin M. Subungual hematoma: association with occult laceration requiring repair. Am J Emerg Med. Jul 1987. 5(4):302-4. [Medline].
Mignemi ME, Unruh KP, Lee DH. Controversies in the treatment of nail bed injuries. J Hand Surg Am. 2013 Jul. 38 (7):1427-30. [Medline].
Garcia-Rodriguez JA. Draining a subungual hematoma: procedures and assessments video series. Can Fam Physician. 2013 Aug. 59 (8):853. [Medline].
Patel L. Management of simple nail bed lacerations and subungual hematomas in the emergency department. Pediatr Emerg Care. 2014 Oct. 30 (10):742-5; quiz 746-8. [Medline].
Meek S, White M. Subungual haematomas: is simple trephining enough?. J Accid Emerg Med. 1998 Jul. 15(4):269-71. [Medline].
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].
Tzeng YS. Use of an 18-gauge needle to evacuate subungual hematomas. J Emerg Med. Jan 2013. 44(1):196-7. [Medline].
Kaya TI, Tursen U, Baz K, Ikizoglu G. Extra-Fine Insulin Syringe Needle: An Excellent Instrument for the Evacuation of Subungual Hematoma. Dermatol Surg. 2003 Nov. 29(11):1141-3. [Medline].
Kain N, Koshy O. Evacuation of subungual haematomas using punch biopsy. J Plast Reconstr Aesthet Surg. Nov 2010. 63(11):1932-3. [Medline].
Khan MA, West E, Tyler M. Two millimetre biopsy punch: a painless and practical instrument for evacuation of subungual haematomas in adults and children. J Hand Surg Eur. Sep 2011. 36(7):615-7. [Medline].
O'Shaughnessy M, McCann J, O'Connor TP, Condon KC. Nail re-growth in fingertip injuries. Ir Med J. December 1990. 83:136-7. [Medline].
Miranda BH, Vokshi I, Milroy CJ. Pediatric nailbed repair study: nail replacement increases morbidity. Plast Reconstr Surg. April 2012. 129:1028. [Medline].
Harrison BP, Hilliard MW. Emergency department evaluation and treatment of hand injuries. Emerg Med Clin North Am. 1999 Nov. 17(4):793-822. [Medline].
Jeys LM, Khafagy R. A useful technique for securing nails: the figure-of-eight suture. Br J Plast Surg. 2001 Oct. 54(7):651. [Medline].
Hallock GG. Expanded applications for octyl-2-cyanoacrylate as a tissue adhesive. Ann Plast Surg. 2001 Feb. 46(2):185-9. [Medline].
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].
Richards AM, Crick A, Cole RP. A novel method of securing the nail following nail bed repair. Plast Reconstr Surg. 1999 Jun. 103(7):1983-5. [Medline].
Hallock GG, Lutz DA. Octyl-2-Cyanoacrylate adhesive for rapid nail plate restoration. J Hand Surg [Am]. 2000 Sep. 25(5):979-81. [Medline].
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]. 2004 Dec. 29(6):634-5. [Medline].
Purcell EM, Hussain M, McCann J. Fashionable splint for nailbed lacerations: the acrylic nail. Plast Reconstr Surg. 2003 Jul. 112(1):337-8. [Medline].
Etoz A, Kahraman A, Ozgenel Y. Nail bed secured with a syringe splint. Plast Reconstr Surg. 2004 Nov. 114(6):1682-3. [Medline].
Bayraktar A, Ozcan M. A nasogastric catheter splint for a nailbed. Ann Plast Surg. 2006 Jul. 57(1):120. [Medline].