Nail avulsion: Difference between revisions
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==Background== | ==Background== | ||
*Generally results from blunt trauma | |||
[[File:Human nail anatomy.jpg|thumb|A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin.]] | [[File:Human nail anatomy.jpg|thumb|A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin.]] | ||
==Clinical Features== | ==Clinical Features== | ||
[[File:PMC4029263 dp0402a18g002.png|thumb|Full nail avulsion. The lunula and nail bed are exposed. The lunula is pinkish-white in color with a smooth surface. The nail bed is bright red in color with longitudinal dermal ridges stretching from the lunula to the distal groove.]] | |||
*Nail completely or partial removed from nailbed | *Nail completely or partial removed from nailbed | ||
*May present with concomitant [[nailbed laceration]] | *May present with concomitant [[nailbed laceration]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{DDX distal finger}} | |||
{{Hand and finger injury DDX}} | {{Hand and finger injury DDX}} | ||
== | ==Evaluation== | ||
*Obtain | *Clinical diagnosis | ||
*Detailed neurovascular exam | *Obtain xray to check for [[finger Fracture|fracture]], [[finger dislocation|dislocation]], and foreign body | ||
*Detailed neurovascular exam noting sensation and capillary refill | |||
==Management== | ==Management== | ||
[[File:PMC3349021 10195 2011 161 Fig2 HTML.png|thumb|(a) Fingernail avulsion; (b) polypropylene nail substitute; (c) clinical result at 12 months.]] | |||
*For partial avulsion, gently lift nail but do not remove to inspect nail bed for laceration | *For partial avulsion, gently lift nail but do not remove to inspect nail bed for laceration | ||
*For complete avulsion: | *For complete avulsion: | ||
**Repair any [[nailbed laceration]] | **Repair any [[nailbed laceration]] | ||
**Replace nail into nailfold after cleaning nail and suture into place | **Replace nail into nailfold after cleaning nail and suture into place | ||
**If no nail, place a non-adherent, petroleum containing gauze into | **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<ref>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</ref> | |||
==Disposition== | ==Disposition== | ||
* | *Discharge | ||
==See Also== | ==See Also== | ||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | |||
[[Category:Dermatology]] | |||
Latest revision as of 18:09, 10 September 2020
Background
- Generally results from blunt trauma
Clinical Features
- Nail completely or partial removed from nailbed
- May present with concomitant nailbed laceration
Differential Diagnosis
Distal Finger (Including Nail) Injury
- Distal interphalangeal dislocation (finger)
- Distal phalanx (finger) fracture
- Finger amputation
- Fingertip avulsion
- Finger infection
- Nailbed laceration
- Nail avulsion
- Subungual hematoma
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
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
- ↑ 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