Nail Bed Injury 883.1

synonyms:

Nail Bed Injury ICD-9

• 883.0 (open wound of finger; includes fingernail; without complication)
• 883.1 (open wound of finger; includes fingernail; with complication)
• 883.0 (open wound of finger; includes fingernail; with tendon involvement)
• 893.0 (open wound of toe; includes fingernail; without complication)
• 893.0 (open wound of toe; includes fingernail; with complication)
• 893.0 (open wound of toe; includes fingernail; with tendon involvement)
• 816.02 (closed, distal phalanx fracture)

Nail Bed Injury Etiology / Epidemiology / Natural History

• Injury generally occurs from fingers getting slambed in doors or from yard or workshop tools. Long finger is most frequently injured.

Nail Bed Injury Anatomy

• Perionychium includes the nail bed, nail fold, eponychium, paronychium, and hyponychium.
• Nail bed = the soft tissue beneath the nail. Including the germinal matrix proximally and the sterile matrix distally.
• Germinal matrix: produces 90% of nail growth. Injury produces absense of the nail.
• Sterile matrix: adds a thin layer of cells to the undersurface of the nail which act to adhere the nail to the nail bed. Injury produces nail deformity.
• Nail fold = the most proximal extent of the perinychium. Has a dorsal roof and ventral floor(germinal matrix).
• Paronychium = skin of the each side of the nail.
• Hyponychium = skin distal to the nail.
• Eponychium = skin proximal to the nail; covers the nail fold.
• Lunula = white arc just distal to the eponychium; represents the distal extent of the germinal matrix.

Nail Bed Injury Clinical Evaluation

• Subungal hematoma's typically cause severe throbbing pain

Nail Bed Injury Xray / Diagnositc Tests

• A/P and lateral views of the finger are indicated to eval for associated fracture.

Nail Bed Injury Classification / Treatment

• Subungal hematoma with intact nail = decompression. Generally done with battery-powered microcautery after sterile prep. Ensure hole is large enough to allow drainage.
• Nail broken of edges disrupted = nail removal with nail bed repair.
• Nail bed lacerations shoulde be reapproximated
• Pulp lacerations require debridement and repair.
• Ensure proximal nail fold is kept open
• Keflex 500mg PO QID x 7 days

Nail Bed Repair (11760)

• Sign operative site.
• Pre-operative antibiotics.
• 1% plain lidocaine digital block.
• Prep and drape
• Finger tourniquet.
• Nail removed with Kutz elevator or iris scissors.
• Undersurface of nail cleared of any residual tissue and soaked in providie-iodine solution.
• Examine nailbed under 2.5x loupe magnification.
• Undermine edges @ 1mm.
• Irrigate.
• Repair with 7-0 chromic sutures, GS-9 opthalmic needle. Simple sutures.
• Place hole in the previously removed nail for drainage and replace nail. If nail is not available use 0.020" reinforced silicone sheeting or nonadherent gauze.
• Suture nail in place with 5-0 nylon suture placed in a horizontal mattress configuration through the nail fold.
• Severely displaced distal phalanx fractures can be reduced and pinned with 0.028 K-wires.

Nail Bed Injury Associated Injuries / Differential Diagnosis

• Distal phalanx (tuft) fracture
• Subungal hematoma

Nail Bed Injury Complications

• Nail deformity
• Nail absence

Nail Bed Injury Follow-up Care

• Typically require 4-5 months for regrowth.

Nail Bed Injury Review References

• Green's Operative Hand Surgery
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