Analysis of Nail Bed Injuries

Abstract

Objective/Hypothesis: The fingertip and nail bed are the most commonly injured parts of the hand and are important aesthetic and functional parts of the hand. Without proper treatment, injury to the nail complex has the potential to cause considerable dysfunction and/or deformity. Despite a high incidence, controversy remains around the appropriate management of nail bed injuries. This study is based on 549 nail bed injuries treated over a 6-year period and be to suggest an appropriate treatment. Materials and Methods: In the retrospective study, we analyzed data from 549 nail bed injuries in 536 patients operated over a 6-year period. At least 6 months follow-up patients were included, and other combined injuries inside the same hand were excluded. Age, type of injury, bony injury (fractures), nail substitute (treatment methods), and outcomes were reviewed. Results were determined for 549 nails after follow-up examination by the authors, and these were divided to identical to opposite group, major and minor abnormalities based on Zook’s criteria. The sum of the minor and major nail abnormalities for each finger was used to determine a grade of excellent (no abnormalities), very good (1 minor), good (2 minor), fair (3 minors and 1 major) or poor (more than 3 minors or 1 major). Statistical analysis was done between the injury category (type, site, nail substitute, and fracture) and the overall final grade. Results: The patients’ age ranged from 7 months to 83 years, with an average of 34 years. The long finger was the most common injured fingers followed by ring, index, thumb, and small finger. Lacerations were the most common type of injury, followed by crushes and avulsions. The most frequent area of nail injury was distal third, with the middle third, nail fold, and proximal third following closely. Fractures accompanied in 182 cases. The nail fold and nail repairs were most often covered with avulsed nail and with silicone sheet for 16 cases. About 50% were excellent (293 cases), 22.6% very good (124 cases), 11.3% good (62 cases), 6.2% fair (34 cases), and 6.6% poor (36 cases). There were no statistically significant differences identified between nail deformities and age, digit, nail substitutes. Crush and avulsive injuries were found to have significantly worse results ( P < .05) compared with lacerations. Poorer results were obtained in fold injuries than other parts ( P < .05). The presence of fracture was associated with poor results ( P < .05). Conclusions: It seemed that the poorer results were related to site of injuries (nail fold), presence of fracture, and type of injury and concluded that the cause were multifactorial. Overall outcomes were good. However, nail splitting, nail roughness, and nail adherence cause dirtiness, catching, bending, and various cosmetic problems. Careful suture and replacement of nail to nail fold were important to reach good results.