Injuries to the nail bed: An examination of images, classifications, and remedies
Nail bed injuries can occur due to a variety of reasons, such as a heavy object crushing or hitting the fingers or toes, or from a cut caused by a sharp object. These injuries can range from minor to severe, and understanding their types and appropriate treatments is crucial for a swift and effective recovery.
Nail bed injuries can be categorised into several types based on the structures involved and the nature of the injury. One common type is the pulp-only injury, which involves damage to the soft tissue under the fingertip without affecting the nail bed. Symptoms include pain, swelling, and possible bleeding or bruising of the fingertip. Treatment for this type of injury usually involves cleaning, wound care, pain control, and dressing, with more severe cases potentially requiring suturing.
Another type is the pulp plus nail bed injury, which involves damage to both the fingertip pulp and the nail bed. Symptoms include pain, swelling, bleeding underneath or around the nail, visible nail bed lacerations or deformity. Treatment for this type of injury requires careful cleaning, possible surgical repair of the nail bed to restore the anatomy, followed by placement or removal of the nail plate depending on the extent of the injury and surgical findings. Post-operative care may include antibiotics to prevent infection and pain management.
The most severe type of nail bed injury is the distal phalanx fracture with nail bed injury, which includes a fracture of the tip bone along with pulp and nail bed injury. Symptoms include severe pain, deformity of the fingertip, bleeding under the nail (subungual hematoma), nail displacement, and sometimes open fracture wound. Treatment for this type of injury may require reduction and fixation of the bone fracture, nail bed repair, drainage of subungual hematoma to relieve pressure and pain, and antibiotics to prevent infection.
Other common nail bed-related conditions include ingrown toenails and fungal nail infections. Ingrown toenails can cause pain, redness, swelling, and possibly infection and discharge if advanced. Treatment for this condition includes conservative care such as warm soaks and antibiotics if infected, with more severe cases potentially requiring nail edge elevation splints or partial nail matrix removal. Fungal nail infections can cause thickened, brittle, discolored nails and nail deformity. Treatment for this condition includes antifungal medications, maintaining a dry environment, and sometimes debridement or laser treatments.
For any severe nail bed injury or if signs of infection develop, seeking prompt medical evaluation is recommended to optimise healing and functional outcome. In cases of avulsion, a surgeon may use reconstructive techniques, such as grafting, to help the nail bed and underlying structures heal. A doctor may also drain pooling blood from a severe subungual hematoma through a process called trephination, but only if the nail is not damaged. In cases of avulsion, the doctor may attach a synthetic nail, which is gradually pushed forward as the new nail grows. If part or all of the nail bed matrix is damaged, the doctor may remove part or all of the nail.
In conclusion, understanding and treating nail bed injuries requires knowledge of their types and appropriate treatments. Seeking prompt medical attention for more serious nail bed injuries is essential, as medical treatments may be necessary. For minor nail bed injuries, home remedies such as cleaning the wound with soap and water, applying an antibiotic ointment, and covering the injury with a bandage can provide temporary relief. However, if symptoms persist or worsen, it is important to seek medical attention to prevent complications and ensure proper healing.
References: [1] [Nail Bed Injuries: A Review of Current Management Strategies](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286525/) [2] [Ingrown Toenail](https://www.nhs.uk/conditions/ingrown-toenail/) [3] [NINJA Trial: A Randomized Controlled Trial of Nail Avulsion Versus Nail Conservation in the Management of Subungual Hematoma in Adults](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5433476/) [4] [Fungal Nail Infections](https://www.nhs.uk/conditions/fungal-nail-infections/) [5] [Subungual Hematoma Drainage: A Review of Techniques and Indications](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436886/)
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