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10.03 Nail Root Dislocation

Presentation

What to do:

• Take an x ray to rule out an underlying fracture (which may require reduction as well as protective splinting.)
• Anesthetize the area using a digital block.
• Lift the base of the nail off the eponychium, and thoroughly cleanse and inspect the nail bed. Minimally debride loose cuticular tissue and test for a possible avulsion of the extensor tendon.
• If bleeding is a problem, establish a bloodless field using a Penrose drain to wrap and tourniquet the finger.
• Repair any nailbed lacerations with a fine absorbable suture like 7-0 or 6-0 Vicryl.
• Reinsert the root of the nail under the eponychium.
• Reduce any underlying angulated fracture.
• If the nail tends to drift out from under the eponychium, it can be sutured in place with two 4-0 nylon or polypropylene stiches in the corners.
• Any non-absorbable sutures should be removed after one week.
• Cover the area with a finger tip dressing and splint any underlying fracture.
• Provide tetanus prophylaxis.
• Followup should be provided in 3-5 days. Instruct patients to return immediately if there is increasing pain or any other sign of infection.
• Prescribe an analgesic like acetaminophen and hydrocodone.

What not to do:

• Do not ignore the nail root dislocation and simply provide a finger tip dressing. This is likely to lead to continued bleeding or to a later infection because tissue planes have not been replaced in their natural anatomic position.
• Do not debride any postion of the nailbed, sterile matrix or germinal matrix.

Discussion:

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES ©
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