5.1 Nailbed Injuries

Pediatric nailbed injuries are commonplace in many hand surgery units (Fig. 5‑1). Adults can be operated on under local anesthesia, but in young children, general anesthesia is needed.

If there is evidence of subungual hematoma, or the nail has been partially avulsed, exploration and repair is usually warranted (Fig. 5‑2, Fig. 5‑3, Fig. 5‑4, Fig. 5‑5). Many of these injuries have tuft fractures that can be managed conservatively. Some surgeons have advocated that the nail plate should not be placed back after repair, due to a possible higher risk of infection, although the nail plate can act as a splint for some fractures of the distal phalanx and may prevent the formation of synechiae. If replaced, the nail plate can be secured with a simple figure of 8 stitch using Vicryl Rapide. Tissue glue can cause problems with prolonged adherence of the old nail plate, in the author’s experience.