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Management of Nail Bed Injuries Associated with Fingertip Injuries

BACKGROUND: Management of nail injuries can often be a challenging experience, especially in presence of complex fingertips’ injuries that include soft tissue loss and distal phalanx injury. Most studies found in the literature focus on individual injuries and describe methods to tackle those injuri...

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Autores principales: George, Alexander, Alexander, Reena, Manju, C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688867/
https://www.ncbi.nlm.nih.gov/pubmed/29200490
http://dx.doi.org/10.4103/ortho.IJOrtho_231_16
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author George, Alexander
Alexander, Reena
Manju, C
author_facet George, Alexander
Alexander, Reena
Manju, C
author_sort George, Alexander
collection PubMed
description BACKGROUND: Management of nail injuries can often be a challenging experience, especially in presence of complex fingertips’ injuries that include soft tissue loss and distal phalanx injury. Most studies found in the literature focus on individual injuries and describe methods to tackle those injuries, notwithstanding the fact that the nail, nailbed, distal phalanx, soft tissue and skin of the finger tip form a complex and often more than one element of this complex is injured. This retrospective study therefore focuses on the management of nail bed injuries as a part of the complex finger tip injury and outlines the surgical principles and techniques that were used in their management. MATERIALS AND METHODS: Two hundred and forty patients from a tertiary care center in different clinical settings where a wide variety of cases involving the nail bed injuries were included in this study. Patients comprised of 192 (80%) males and 48 (20%) females with the average male age of 37.3 years (range 1-66 years) and average female age of 29 years (range 1-59 years). 210 patients had single finger involment, 30 patients had two finger involvement (total fingers involved- 270). The middle finger was most commonly involved while the index finger was the second most commonest finger involved. In 198 (89.18%) patients local anaesthesia was used while in the rest: regional blocks [n = 10 (4.5%)] and general anaesthesia [n = 14 (6.3%)] were used. RESULTS: In this retrospective study, out of the total of two hundred and forty patients, 222 (92.5%) patients underwent surgery, while the rest 18 (7.5%) were treated conservatively. Two hundred and ten patients who underwent surgery had complete healing over the course of treatment and followup, while four patients needed secondary interventional. Eight patients who had surgery were migrant workers were lost to follow up after surgery. Eight patients had postoperative complications that included infection, secondary necrosis, wound breakdown and non healing fractures. CONCLUSION: Accurate and timely diagnosis of nail bed injury and its meticulous repair is cardinal to the management of any nail bed injury. However all nail bed injuries must be seen in the context of associated injuries of the finger tip complex, namely skin, soft tissue and distal phalanx injuries. Fixation of associated bony injury which closely underlines the nail bed and provides physical support to the nail bed along with correction of soft tissue injuries in the form of flaps or grafts, compounded by the repair or replacement of nail plate in the first 24 hours.
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spelling pubmed-56888672017-12-01 Management of Nail Bed Injuries Associated with Fingertip Injuries George, Alexander Alexander, Reena Manju, C Indian J Orthop Original Article BACKGROUND: Management of nail injuries can often be a challenging experience, especially in presence of complex fingertips’ injuries that include soft tissue loss and distal phalanx injury. Most studies found in the literature focus on individual injuries and describe methods to tackle those injuries, notwithstanding the fact that the nail, nailbed, distal phalanx, soft tissue and skin of the finger tip form a complex and often more than one element of this complex is injured. This retrospective study therefore focuses on the management of nail bed injuries as a part of the complex finger tip injury and outlines the surgical principles and techniques that were used in their management. MATERIALS AND METHODS: Two hundred and forty patients from a tertiary care center in different clinical settings where a wide variety of cases involving the nail bed injuries were included in this study. Patients comprised of 192 (80%) males and 48 (20%) females with the average male age of 37.3 years (range 1-66 years) and average female age of 29 years (range 1-59 years). 210 patients had single finger involment, 30 patients had two finger involvement (total fingers involved- 270). The middle finger was most commonly involved while the index finger was the second most commonest finger involved. In 198 (89.18%) patients local anaesthesia was used while in the rest: regional blocks [n = 10 (4.5%)] and general anaesthesia [n = 14 (6.3%)] were used. RESULTS: In this retrospective study, out of the total of two hundred and forty patients, 222 (92.5%) patients underwent surgery, while the rest 18 (7.5%) were treated conservatively. Two hundred and ten patients who underwent surgery had complete healing over the course of treatment and followup, while four patients needed secondary interventional. Eight patients who had surgery were migrant workers were lost to follow up after surgery. Eight patients had postoperative complications that included infection, secondary necrosis, wound breakdown and non healing fractures. CONCLUSION: Accurate and timely diagnosis of nail bed injury and its meticulous repair is cardinal to the management of any nail bed injury. However all nail bed injuries must be seen in the context of associated injuries of the finger tip complex, namely skin, soft tissue and distal phalanx injuries. Fixation of associated bony injury which closely underlines the nail bed and provides physical support to the nail bed along with correction of soft tissue injuries in the form of flaps or grafts, compounded by the repair or replacement of nail plate in the first 24 hours. Medknow Publications & Media Pvt Ltd 2017 /pmc/articles/PMC5688867/ /pubmed/29200490 http://dx.doi.org/10.4103/ortho.IJOrtho_231_16 Text en Copyright: © 2017 Indian Journal of Orthopaedics http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
George, Alexander
Alexander, Reena
Manju, C
Management of Nail Bed Injuries Associated with Fingertip Injuries
title Management of Nail Bed Injuries Associated with Fingertip Injuries
title_full Management of Nail Bed Injuries Associated with Fingertip Injuries
title_fullStr Management of Nail Bed Injuries Associated with Fingertip Injuries
title_full_unstemmed Management of Nail Bed Injuries Associated with Fingertip Injuries
title_short Management of Nail Bed Injuries Associated with Fingertip Injuries
title_sort management of nail bed injuries associated with fingertip injuries
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688867/
https://www.ncbi.nlm.nih.gov/pubmed/29200490
http://dx.doi.org/10.4103/ortho.IJOrtho_231_16
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