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10.03 Nail Root Dislocation


Presentation

The patient has caught his finger in a car door or dropped a heavy object like a can of vegetables on a bare toe, with the edge of the can striking the base of the toenail and causing a painful deformity. The base of the nail will be found resting above the eponychium instead of in its normal anatomical position beneath. The cuticular line that had joined he eponychium at the nail fold will remain attached to the nail at ts original position.

What to do:

What not to do:

Discussion:

Because the nail is not as firmly attached at the base or lunula as it is to the distal nail bed, impact injuries can avulse only the base (nail root) leaving it lying on top of the eponychium. It may be surprising that this injury is often missed but at first glance, a dislocated nail can appear to be in place, and without careful inspection, a patient can return from radiology with negative x rays and be treated as if he only had an abrasion or contusion. The attachment of the cuticle from the nailfold of the eponychium to the base of the nail forms a constant landmark on the nail. If any nail is showing proximal to this landmark it indicates that the nail is not in its normal position beneath the eponychium.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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Michael Gillam, MD