Traditionally it has been said that if the surface area of haematoma is less than 50% of the nail surface area or the patient is asymptomatic and if the X ray does not show any fracture it may be managed conservatively. This can result in a subungual haematoma – collection of blood between the nail bed and the nail plate. Proper management of these injuries is essential not only to get them to heal quickly but also to prevent complications and the resultant late deformities.Ĭlosed injuries to the nail can happen when there is a mild crushing of the finger tip as in a door crush injury or when a weight like hammer falls over it. Self-inflicted injuries happen in conditions as nail biting or insertion of artificial nail or improper manicure. Iatrogenic injuries can occur from traumatic nail plate removal for procedures or during placement of K wires. This can result in partial loss of nail bed also. Avulsion injuries can result from crush or grinding type injuries. Sharp lacerations can occur when objects land with enough force to penetrate the nail plate. The nail bed gets squeezed between the hard nail and distal phalanx resulting in simple or complex lacerations. ![]() The aetiological factor may be industrial as in crush injuries due to machines, road traffic accidents or sometimes even in the sports where it gets hurt by a ball or a weight. The most common cause of acute and chronic nail bed deformity is trauma. The term paronychium refers to the fold on each lateral aspect of the nail. Below the distal attachment of the nail with the pulp skin is the plug of keratinous mass called hyponychium, which is rich in polymorphs and lymphocytes which act as a barrier to infection. The nail fold consists of the germinal matrix and eponychium. The nail bed distal to this is the sterile matrix and proximal to that is the germinal matrix. The white arc on the nail just distal to eponychium is the lunula. Underneath the nail plate there lies the nail bed. The fine filamentous material attaching nail to eponychial fold is the nail vest. Eponychium refers to the soft tissue proximally on the dorsum of nail continuing to the dorsal skin. The perionychium refers to the nail and surrounding structures including the hyponychium, nail bed and nail fold. At birth a well-grown nail indicates maturity of the foetus. Nail forms at approximately 10 weeks of intrauterine life from sole plate appearing on dorsum of each finger. A proper knowledge and understanding of nail anatomy is very much essential for proper treatment of various conditions affecting it. Nail loss or deformity is not only unaesthetic in appearance but can be functionally incapacitating. ![]() The nail helps to increase the sensory perception in the pulp and helps in picking up small objects. Nail is a specialised structure found only in primates although other mammals have modification of these.
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