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10.04 Finger or toenail avulsion


Presentation

The patient may have had a blow to the nail; the nail may have been torn away by a fan blade or other piece of machinery; or a long hard toenail may have caught on a loop of a shag carpet or other fixed object and been pulled off the nailbed. The nail may be completely avulsed, partially held in place by the nail folds, or adhering only to the distal nail bed. On occasion, an exposed nailbed will have a pearly appearance with minimal bleeding making it seem as if the nail is still in place when actually it has been completely avulsed.

What to do:

What not to do:

Discussion:

Although the eponychium is unlikely to scar to the nailbed unless there is infection, inflammation, or considerable tissue damage, separating the eponychium from the nail matrix by reinserting the nail or inserting an artificial stent helps to prevent synechia and future nail deformities from developing. The patient's own nail is also his most comfortable dressing. Minimally traumatized avulsed nails can actually grow normally if carefully replaced in their proper anatomic position. A gauze stent left in the nail sulcus will be pushed out as the new nail grows. Complete regrowth of an avulsed nail usually requires four to five months at one milimeter per week.

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