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Nail avulsion
From WikEM
Contents
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
Hand and finger injuries
- Radiograph positive
- Radiograph negative
- Dupeytren contracture
- Boutonniere deformity
- Hand and finger tendon injuries
- Ganglion cyst
- De Quervain tenosynovitis
- Intersection syndrome
- Drummer's wrist
- Extensor digitorum tenosynovitis
- Vaughn Jackson syndrome
- Snapping Extensor Carpi Ulnaris
- Compressive neuropathy, "bracelet syndrome"
- Scaphoid fracture
- Osteoarthritis
- Infiltrative tenosynovitis
- Gout
- Rheumatoid arthritis
- Trigger finger
- Mallet finger
- Jersey finger
- Jammed finger
- Subungual hematoma
- Fingertip laceration
- Metacarpophalangeal (MCP) ulnar ligament rupture (Gamekeeper's thumb)
- Nail avulsion
- High-pressure injection injury
Evaluation
- 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 nail fold. Can Also use aluminum wrapping of suture package as pseudo-nail to allow appropriate spacing for new nail to grow in.
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[1]
See Also
External Links
References
- ↑ Lammers, R.L. and Smith, Z.E. Chapter 35: Methods of Wound Closure. In: Roberts, J ed. Roberts and Hedges' Clinical Procedures in Emergency Medicine. Elsevier; 2014:644-689
