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Flashcards in Nail Bed injuries Deck (17):
1

What types of nail bed injuries are there?

Subungual haematoma

Nail bed Laceration

Nail bed avulsion

 

2

What are the most common hand injuries seen in A/E?

Finger tip injuries

3

What is the pathophysiology of nail tip injuries?

Crush between 2 objects

Catch finger in closing door

Saw injury

Direct blow from hammer

4

What are the associated conditions?

Fracture or dislocation of the DIP

5

What is the prognosis of the condition?

Early operative treatment best outcome

Better outcome with fracture fixation and repair of nail bed at same time

6

Can you draw and name the sections through a nail?

Hyponychium- skin immediately palmar to nail, at junction of sterile matrix and fingertip skin

Eponychium- the dorsal nail fold, proximal to nail plate

Lunula- white portion of  proximal nail

Perionychium- entire area includes- nail/nailbed/surrounding skin

Paronychium- Lateral nail fold

Sterile matrix- soft tissue deep to and adherent to nail, distal to Lunula

Germinal Matrix- responsible for nail development

Perosteum of distal phalanx- immediately volar to sterile matrix

Extensor tendon insertion to Germinal  matrix is 1.2-1.4 mm

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7

What is the position of the sterile matrix?

Distal to Lunula

Aherent to nail

Soft tissue deep to nail

8

What is the position and role of the germinal matrix?

proximal to STERILE matrix

extensor tendon is 1.2-1.4 mm proximal to germinal matrix

responsible for nail development

 

9

What do you examine with a pt suspected of nail bed injury?

What investigations would you order?

Pain

Subungual haematoma

nail bed integrity

 

Xray Ap, lateral and oblique to rule out fracture

10

What is this? and its treatment?

Q image thumb

Subugual haematoma

1) if less than 50% nail involved incise and drain using electrocautery/ needle

2) if greater than 50% nail bed removal , incision and drainage and nail bed repair

1

11

What is this and what is its treatment?

Q image thumb

Nail bed laceration 

Tx by nail removal ,  incision and drainage  with nail bed repai using 6.0 

NB: don't forget tetanus and prophylaxtic antibiotics

12

What is and its treatment?

Q image thumb

Nail avulsion and portion of nail bed loss

Usually high energy injuries- commonly associated with fractures

tx 1) nail removal, nail bed repair +/- FX fixation = with minimal loss of matrix 

2) nail removal, nail bed repair, split skin graft vs matirx nail transfer +/- FX fixation= avulsion of sig loss of matrix, nail matrix transfer from neighbouring injured finger or 2nd toe

 

 

13

Describe how would you repair a nail bed injury?

Soak nail in betadine

Repair nail bed with 6.0 or smaller absorable suture

RCT shown quicker repair time with Dermabond (2-octylcyanoacrylate) cf sutures- similar cosmesis and functional 

support eponychial fold with original nail, foil, non adherent gauze

 

14

What are the complications of nail bed injuries?

Hook nail ( picture)

Split nail

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15

What is the complication and cause of the picture?

How is it treated?

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Hook nail

Advancement of the matrix to obtain coverage without adequate bony support

tx= Remove nail and trim matirx to level of bone

16

What is the compliciation and cause of the picture?

How is it treated?

Q image thumb

 

Split nail

Scarring of matrix following injury to nail bed

TX: excise scar tissue and replace nail bed

17

What is this called and how do you treat it?

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Seymour fracture- juxtaepiphyseal fracture of the distal phalanx

Treatment of a nail bed avulsion and physeal separation is irrigation and debridement, physeal reduction, nail bed repair and immobilization. The primary goals are to achieve a stable, viable nail and good cosmetic results.

Inglefield at al JBJS 95 retrospectively reviewed 19 children with 22 nail bed injuries. Early operative repair led to good to excellent results in 91% of patients. They concluded that repair of the nail bed at the time of injury is superior to secondary correction

Fassler JAm Ac O Surg 1996 -reviewed fingertip injuries, providing recommendations for treatment based on degree of soft tissue loss, bone exposure, feasibility for flap coverage and the presence or absence of mitigating systemic conditions. He also concluded that the outcome of nail bed injuries is dependent on the severity of injury to the germinal matrix.