Examination of the anatomic relationship of the proximal germinal nail matrix to the extensor tendon insertion

The purpose of this study was to delineate the relationship of the terminal extensor tendon insertion to the proximal limit of the germinal nail matrix. Sixteen fresh-frozen human cadaver fingers without any evidence of trauma (average age, 55 years; 3 males and 1 female) were used for this study. Under x25 magnification the proximal limit of the germinal nail matrix and the terminal bony insertion of the extensor tendon were identified. The distance from the terminal tendon insertion to the germinal nail matrix was ascertained using precision calipers. The average distance from the terminal extensor tendon insertion to the proximal edge of the germinal nail matrix was found to be 1.2 mm. We conclude that the proximal limit of the germinal matrix is extremely close to the terminal extensor tendon bony insertion. When the extensor tendon insertion is visualized during operative exposures of the dorsum of the distal phalanx, care should be taken to avoid damaging the germinal matrix. Conversely, when the nail bed is being completely excised, visualization of the insertion of the extensor tendon will indicate that further proximal dissection is not required.