Nail avulsion

Background

• Can be complete or partial
• Result from blunt trauma

Clinical Features

• Nail completely or partial removed from nailbed
• May present with concomitant nailbed laceration

Differential Diagnosis

• Subungual hematoma
• Distal Phalanx (Finger) Fracture
• Nailbed laceration

Diagnosis

• Obtain hand xray to check for fracture, dislocation, and foreign body
• Detailed neurovascular exam of hand 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 nailfold.

Disposition

• Keep nail splint or gauze in place for 2-3 weeks
• Re-eval wound in 3-5 days and if gauze was placed in nailfold replace with new gauze