Nail Bed Injury
Nail Bed Injury ICD-9
- 883.0 (open wound of finger; includes fingernail; without complication)
- 883.1 (open wound of finger; includes fingernail; with complication)
- 883.0 (open wound of finger; includes fingernail; with tendon involvement)
- 893.0 (open wound of toe; includes fingernail; without complication)
- 893.0 (open wound of toe; includes fingernail; with complication)
- 893.0 (open wound of toe; includes fingernail; with tendon involvement)
- 816.02 (closed, distal phalanx fracture)
Nail Bed Injury Etiology / Epidemiology / Natural History
- Injury generally occurs from fingers getting slambed in doors or from yard or workshop tools. Long finger is most frequently injured.
Nail Bed Injury Anatomy
- Perionychium includes the nail bed, nail fold, eponychium, paronychium, and hyponychium.
- Nail bed = the soft tissue beneath the nail. Including the germinal matrix proximally and the sterile matrix distally.
- Germinal matrix: produces 90% of nail growth. Injury produces absense of the nail.
- Sterile matrix: adds a thin layer of cells to the undersurface of the nail which act to adhere the nail to the nail bed. Injury produces nail deformity.
- Nail fold = the most proximal extent of the perinychium. Has a dorsal roof and ventral floor(germinal matrix).
- Paronychium = skin of the each side of the nail.
- Hyponychium = skin distal to the nail.
- Eponychium = skin proximal to the nail; covers the nail fold.
- Lunula = white arc just distal to the eponychium; represents the distal extent of the germinal matrix.
Nail Bed Injury Clinical Evaluation
- Subungal hematoma's typically cause severe throbbing pain
Nail Bed Injury Xray / Diagnositc Tests
- A/P and lateral views of the finger are indicated to eval for associated fracture.
Nail Bed Injury Classification / Treatment
- Subungal hematoma with intact nail = decompression. Generally done with battery-powered microcautery after sterile prep. Ensure hole is large enough to allow drainage.
- Nail broken of edges disrupted = nail removal with nail bed repair.
- Nail bed lacerations shoulde be reapproximated
- Pulp lacerations require debridement and repair.
- Ensure proximal nail fold is kept open
- Keflex 500mg PO QID x 7 days
Nail Bed Repair (11760)
- Sign operative site.
- Pre-operative antibiotics.
- 1% plain lidocaine digital block.
- Prep and drape
- Finger tourniquet.
- Nail removed with Kutz elevator or iris scissors.
- Undersurface of nail cleared of any residual tissue and soaked in providie-iodine solution.
- Examine nailbed under 2.5x loupe magnification.
- Undermine edges @ 1mm.
- Repair with 7-0 chromic sutures, GS-9 opthalmic needle. Simple sutures.
- Place hole in the previously removed nail for drainage and replace nail. If nail is not available use 0.020" reinforced silicone sheeting or nonadherent gauze.
- Suture nail in place with 5-0 nylon suture placed in a horizontal mattress configuration through the nail fold.
- Severely displaced distal phalanx fractures can be reduced and pinned with 0.028 K-wires.
Nail Bed Injury Associated Injuries / Differential Diagnosis
- Distal phalanx (tuft) fracture
- Subungal hematoma
Nail Bed Injury Complications
- Nail deformity
- Nail absence
Nail Bed Injury Follow-up Care
- Typically require 4-5 months for regrowth.
Nail Bed Injury Review References