ТРАВМА НОГТЕВОГО КОМПЛЕКСА: СОВРЕМЕННЫЙ ВЗГЛЯД НА ПРОБЛЕМУ ОКАЗАНИЯ МЕДИЦИНСКОЙ ПОМОЩИ

Abstract

Despite the fact that the first decade of the XXI century was proclaimed by the World Health Organization as the decade of bone and joint treatment, defining the prevention and treatment of limb injuries as one of the five priority problems of musculoskeletal diseases, there is still no developed generally accepted algorithm for the management of patients with nail phalanx injuries, and the opinions of specialists are often diametrically divergent. Trauma to the distal phalanx of the fingers is one of the most common hand injuries in patients seeking emergency medical care, regardless of gender, age, or occupation. The consequences of nail phalangeal injuries worsen the aesthetic appearance of the hand, reduce the ability to work, and sometimes may even lead to a change in the patients' occupation. When nail complex trauma is combined with a distal phalanx fracture, it is necessary not only to restore the integrity of the nail bed, but also to stabilize the bone fragments. An important point in such situations is the use of a nail plate to temporarily cover the restored nail bed. Firstly, it serves as a stabilizing element for the reponated phalangeal fragments. Secondly, its use leads to a decrease in the percentage of scar formation in the nail bed. During the study, in 39 (37 patients, 80.4%) cases we found an excellent, in 7 (3 patients, 6.5%) – good and in 8 (6 patients, 13.1%) – satisfactory result of treatment. As a result of our study, we have proved that temporary covering of the nail bed with a utilized nail plate or artificial nail plate graft: a) reduces pain during the subsequent stage dressings at the outpatient stage; b) promotes normal growth of a new nail plate; c) accelerates the healing process, as traumatization of the nail bed is minimized; d) the nail plate acts as a natural splint, due to which, in most cases, no additional external fixation is required.