Assessment
- Mechanism and contamination
- Tissue loss
- Nail bed injury
- Exposed bone or tendon
- Sensation and vascularity
- Child versus adult
Classification
Useful to describe the level of injury and whether the nail bed and distal phalanx are involved.
Treatment principles
- Preserve length where possible
- Restore sensate durable cover
- Repair nail bed accurately
- Treat associated distal phalanx fracture appropriately
Options
- Simple dressing for small pulp injuries without exposed bone
- Nail bed repair
- Composite graft in selected children
- V-Y advancement flap, cross-finger or thenar flap for tissue loss
- Shortening and primary closure if necessary
Complications
- Nail deformity
- Hook nail
- Cold intolerance
- Hypersensitivity
- Stiffness
Diagram
