Fingertip-Nail Bed Injuries in Children: Current Concepts and Controversies of Treatment

Crush injuries of the fingertip are the most common hand injuries seen in children. Many involve fracture of the distal phalanx, whereas others result in either crush alone or complete or partial fingertip amputation. The need for nail removal and nail bed repair after crush injury to the fingertip has long been a matter of debate. In our study comparing the outcome of nail removal and formal nail bed reconstruction versus simple evacuation of the subungual hematoma via trephination after fingernail crush injuries, simple nail trephination was equal to, or superior to, removal of the nail and nail bed repair with significantly lower cost (Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg [Am] 1999;24:1166-1170).