Traumatic Nail injuries

Traumatic nail injuries are very common. They usually result from a direct impact such as a bed post or can be due to crushing injuries. 

This is a case of a healthy young female patient who dropped a lamp post on her great toe. It is important to take X-rays for such injuries to rule out fractures. In her case we noticed a small fracture on the distal tuft. More often than not, if there is blood underneath the nail bed or if the nail is loose, a temporary nail avulsion is performed under anesthesia to rule out laceration of the nail bed. This patient did in fact have a laceration of the nail bed, effectively making this an open foot fracture. This was treated by suturing the nail bed with absorbable sutures and she was placed on a short course of broad spectrum antibiotics as prophylaxis. 

What not to do? 

As you can see in the picture, this patient was seen by a doctor in the emergency room and they sutured the loose nail back to the nail bed. I see this very often and this essentially serves no purpose. When the patient sees the specialist, they have to undergo local anesthesia again for the nail to be removed properly.