Introduction
Injuries to the
nail are often associated with damage to other structures
that are in the same location. These include fractures of
the bone, and/or cuts of the nailbed, fingertip skin, tendons
that straighten or bend the fingertip, and nerve endings.
Causes
Many result
from crush injuries after getting the fingertip caught in
a door. Any type of pinching, crushing, or sharp cut to the
fingertip may result in injury to the nail bed.
Nail Bed Injuries
Presentation
Simple
crushes of the fingertip may result in a very painful collection
of blood under the nail. More severe injuries can result in
cracking of the nail into pieces, or tearing off of pieces
of the nail and/or fingertip, and possible injuries to the
adjacent structures.
Diagnosis
An accurate
history of the cause of the injury should be obtained. X-rays
are recommended to look for associated fractures that may
require treatment.
Other
medical conditions that may affect healing should be discussed
with your physician.
Treatment
Restoring
the normal anatomy of the nail and surrounding structures
is the goal of treatment. Simple hematomas are drained by
making a small hole in the nail in order to relieve the pressure
and provide pain relief. Straightforward cuts are repaired
to put the parts back where they belong.
Repairing
the nail bed to which the fragments of bone are attached usually
restores alignment of many fractures of the fingertip. Larger
fragments of bone may need to be pinned or require splinting
to heal the fracture. Missing areas of nail bed can be grafted
from the same finger or from other digits.
Tendon
injury may require splinting or pinning. Local flaps of skin
may be used to replace missing skin, or the open area of skin
may be allowed to just heal on its own, or covered with a
skin graft.
Prognosis
The final
appearance and function of the nail and surrounding structures
depends on the ability to restore the normal anatomy. If the
injury is sharp and can be repaired, a normal nail is likely.
If there is more severe crushing of the nail bed, then there
is a greater likelihood of nail bed scarring and subsequent
deformity of the nail. If the germinal matrix is injured,
there will likely be a deformity of the nail as it grows.
The function
of the fingertip also depends on the extent of injury to structures
other than the nail. It normally takes three to six months
for the nail to grow from the cuticle to the tip of the finger.
Surgical Reconstruction
Loss of
part or all of the nail bed can be reconstructed with grafts
from other digits. Grafts may be taken from the nail bed of
a toe to prevent further injury or deformity of the fingers.
The most common graft is a split-thickness graft to reconstruct
missing nail bed.
