Nail avulsion: Difference between revisions

Latest revision as of 18:09, 10 September 2020

Background

Generally results from blunt trauma

A. Nail plate; B. lunula; C. root; D. sinus; E. matrix; F. nail bed; G. hyponychium; H. free margin.

Clinical Features

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
May present with concomitant nailbed laceration

Differential Diagnosis

Distal Finger (Including Nail) Injury

Hand and finger injuries

Distal finger
Other finger/thumb
- Boutonniere deformity
- Mallet finger
  - Swan neck deformity
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
Hand
- Dupuytren contracture
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

(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 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

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

Authors:

[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

[1]

@@ Line 1: / Line 1: @@
 ==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.]]
-*Can be complete or partial
-*Result from blunt trauma
 ==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
 *May present with concomitant [[nailbed laceration]]
 ==Differential Diagnosis==
+{{DDX distal finger}}
 {{Hand and finger injury DDX}}
-==Diagnosis==
+==Evaluation==
-*Obtain hand xray to check for fracture, dislocation, and foreign body
+*Clinical diagnosis
-*Detailed neurovascular exam of hand noting sensation and capillary refill
+*Obtain xray to check for [[finger Fracture|fracture]], [[finger dislocation|dislocation]], and foreign body
+*Detailed neurovascular exam noting sensation and capillary refill
 ==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 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.
+**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==
-*Keep nail splint or gauze in place for 2-3 weeks
+*Discharge
-*Re-eval wound in 3-5 days and if gauze was placed in nailfold replace with new gauze<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>
 ==See Also==
 ==External Links==
 ==References==