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Nail Bed Injury S61.229A 883.1

 

synonyms:

 

Nail Bed Injury ICD-10

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

 

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