This is a Crushing Injury to the Fingertip injuring the Nail Tip and Bed.
A relevant history is required including: handedness; occupation; mechanism of injury; and co-morbidities.
After History we should provide tetanus prophylaxis (if indicated) and antiseptic (betadine) dressing.
Then we should obtain radiographs to exclude an underlying fracture.
As defnitive management, I would explore and repair the nail bed under local anaesthesia (digitalblock) and digital tourniquet.
The salient steps of the procedure are:
— Remove the nail plate carefully
— Remove the nail plate carefully
— Inspect the nail bed and wash thoroughly
— Copious lavage of any underlying fracture
–Reduce fracture if present and stabilize (axial k-wire; remove after 3–4 weeks) if necessary
— Repair nail bed with a 6-0 absorbable suture (VICRYL)
— Wash and replace nail plate.
— Figure-of-eight stitch (or equivalent) to hold the nail plate in place
What would you explain to the patient?
I would explain that the nail plate will fall off and be gradually replaced by a new one, which may initially appear disfigured.
There is a risk of some long-term nail deformity and discomfort in the region of the nail bed and some distal interphalangeal joint stiffness.
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