Morning Report: 1/13/2015

by Jay Khadpe MD • January 13, 2015 • Comments Off

Thanks to Dr. Wang for presenting today’s Morning Report!

Nailbed Injuries

Typically caused by crush injuries with hammer, in doorway, or car doors. Trauma by saws, knives, or drills can also cause these injuries
- Subungual hematoma: 50% have underlying nailbed laceration
- Nailbed injuries: nailbed lacerations

Workup includes xrays to rule out fracture. 50% of nailbed injuries have associated fractures

Repair
- Subungual hematoma: trephination

Nail plate avulsion
- Digitally block with 1% lidocaine without epi
- Tourniquet the finger for blood-free field
- Remove nail: elevate/separate nailplate from nailbed with iris or fine scissors. DO NOT cause further damage to nail bed. Use hemostat gently remove nail.
- Nailbed laceration is repaired with 6-0 absorbable sutures
- Use native nail (if you can) as a stent to keep the nail fold open for new nail growth
- Use aluminum suture packing as splint if native nail not available
- Place native nail or splint into the nail fold and suture in place with 5-0 or smaller nylon
  - Distally through the hyponychium and nail
  - Through paronychia and nail bilaterally
  - Through the nail and proximal nail fold
  - Horizontal mattress through proximal nail fold
  - Dorsal figure of eight suture (spork method)
- Dermabond can be used
- Dress with non-adherent gauze

Consult hand if significant avulsed matrix or severe crush injury
Tetanus, Pain control
Follow up in 2-3 days for wound check. Sutures to be removed after 2-3 weeks.

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.

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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital