GUNJAN

MECHANISM
 Direct trauma to finger tip. Injury includes
1. Subungal hematoma
2. Nail bed laceration
3. Nail bed avulsion
Pathophysiology
 Mechanism of injury includes
1. Crushing fingertips between two objects.
2. Catching finger in a closing door
3. Saw injury
4. Snow blower injury
5. Direct blow from a hammer
Associated conditions
DIP fractures or dislocations
Anatomy

 Nailbed and surrounding tissue

1. Perionychium – nail, nailbed,surrounding skin
2. Paronychium-lateral nail folds
3. Hyponychium-skin distal and palmar to nail
4. Eponychium –dorsal nail fold , proximal nail fold.
5. Lunula –white part of the proximal nail
6. Matrix-
Sterile : soft tissue deep to nail , adheres to nail
Germinal : responsible for most nail development, insertion
of extensor tendon is 1.2 to 1.4 proximal to germinal
center.
Presentation
 Pain
SIGNS:
Examine for subungal hematoma
Inspect nail integrity
XRAY:
AP ,lateral and oblique of finger- to rule out fracture
SUBUNGAL HEMATOMA
 Most commonly caused by a crushing type injury-
causes bleeding beneath nail.
 Treatment:
Hematoma drainage by perforation
Indication : less than 50 % nail involved
Techniques:1. puncture nail using sterile needle
electrocautery to perforate nail
2.Nail removal with D & I ,nail bed repair.
Nail Bed Laceration
 Laceration of nail and underlying nail bed
 Usually present with intact nail and subungal
haematoma >50 % of nail surface.
 Treatment:
1. Nail removal
2. Incision and Drainage
3. Nail bed repair
Avulsion Injury
 Avulsion of nail and protrusion of underlying nail bed.
 Mechanism : high energy injury
 Associated injury : distal phalanx fracture
 Treatment :
1. Nail removal
2. Nail bed repair
3. If fracture is there should be fixed.
Surgical options
 Indication :
Avulsion injury with minimal or no loss of nail matrix
with or without fracture.
 Technique :
1.Tetanus and Antibiotics
2.Nail removal ,nail bed repair
3.Split thickness graft vs nail matrix transfer +/- fracture
fixation
Surgical Option
 Indication : avulsion or crush injury with significant
loss of nail matrix
 Technique:
1.Tetanus and intravenous antibiotics
2.Nail matrix transfer from adjacent injured finger or
nail matrix transfer from second toe.
3. Fracture fixation depends on type of fracture.
Nail Bed Repair
 Soak nail in betadine
 Repair nail bed with 6.0 or Absorbable suture.
 Better with 2.0 octylcyanoacrylate
 Split eponychial fold.
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