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Management of Simple Nail Bed Lacerations and Subungual Hematomas in the Emergency Department

Patel, Lina MD

doi: 10.1097/PEC.0000000000000241
CME Review Article

Fingertip crush injuries are common hand injuries in children and often are evaluated initially in an emergency department. Nail bed injuries can be classified into subungual hematomas, simple or stellate lacerations, crush injuries, and avulsions. Emergency department physicians with good knowledge of fingertip anatomy can appropriately manage these injuries so as to prevent long-term fingertip deformities and functional deficits. The management of simple nail bed lacerations and subungual hematomas has remained somewhat controversial with much debate surrounding the necessity of removing the nail plate for repair of a nail bed laceration versus trephination alone of a large subungual hematoma. This article will discuss the management and evaluation of simple nail bed injuries by emergency department physicians to prevent chronic nail and fingertip deformities.

Pediatric Emergency Medicine Attending, Assistant Professor, Department of Pediatrics, Division of Pediatric Emergency Medicine, Children’s Mercy Hospital & Clinics, University of Missouri-Kansas City, Kansas City, MO.

The author and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.

Reprints: Lina Patel, MD, The Children’s Mercy Hospital and Clinics, 2401 Gilham Rd, Kansas City, MO 64108 (e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.