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Epidemiology and Outcome of Nailbed Injuries Managed in Children's Emergency Department: A 10-Year Single-Center
Vigil James1, Thurston Yan Jia Heng1, Qai Ven Yap2
1From the Children's Emergency, KK Women's and Children's Hospital.
Insights
Pediatric nailbed injuries, often caused by preventable door crush incidents, require careful assessment and repair by pediatric emergency doctors. Understanding injury patterns and predictors of complications is key to optimal outcomes.
Area of Science:
- Pediatric Hand Surgery
- Trauma Surgery
- Nailbed Injuries
Background:
- Nailbed injuries are common in children, contributing significantly to the burden of pediatric hand trauma.
- These injuries frequently occur in young patients and necessitate specific management strategies.
Purpose of the Study:
- To analyze the epidemiology, injury patterns, and treatment of pediatric nailbed injuries (ages 0-18).
- To identify acute and chronic complications associated with these injuries.
- To determine predictors for complications and antibiotic use.
Main Methods:
- Retrospective single-center study.
- Data collected from October 1, 2009, to October 31, 2019.
- Analysis of 457 pediatric upper extremity nailbed injuries.
Main Results:
- Door crush injuries were the most common (59.5%), predominantly occurring at home.
- Simple nailbed laceration with partial nail avulsion was the most frequent injury type (44.4%).
- Injury type (stellate laceration, severe crush) and distal phalanx fracture predicted complications and antibiotic use.
Conclusions:
- Pediatric emergency doctors managed most nailbed injuries (72.2%).
- Preventable mechanisms like door crushes highlight the need for caregiver education.
- Meticulous repair and understanding injury predictors are crucial for minimizing complications such as fingertip sensitivity and deformities.
Background:
Fingertip injuries are among the most common hand injuries in children and result in significant health, time, and a financial burden. Nailbed injuries constitute a large proportion of fingertip injuries and are frequent in children.
Objectives:
This study aimed to examine the epidemiology, injury patterns, and treatment strategies implemented in patients with nailbed injuries between 0 and 18 years of age. We also wanted to identify various acute and chronic complications associated with nailbed injuries in these patients.
Methods:
This was a single-center retrospective study carried out on the data collected between October 1, 2009, and October 31, 2019.
Results:
We identified 457 patients with upper extremity nailbed injuries during the study period. Most children were male, accounting for 62.8% (287) of the patients. Door crush injuries (59.5%) resulted in the majority of the nailbed injuries. The commonest place of injury occurrence was home (46.4%), followed by playground (28.4%). The next most frequent areas were public areas (17.5%) and school (7.7%). Simple nailbed laceration with partial avulsion of the nail (44.4%) was the most common type of nailbed injury. Most nailbed injury repairs were done by the pediatric emergency doctor (72.2%). The predictors for the occurrence of complications after nailbed injury were the type of injury (stellate laceration and severe crushed nailbed injuries) and fracture of the distal phalanx. The predictors for the use of antibiotics after nailbed injury in our patients were the mechanism of injury (crushed in door, sports injury, and road traffic accident) and fracture of the distal phalanx. Age was found to be associated with subungual hematomas and avulsion, whereas female sex was found to be associated with crush injuries.
Conclusions:
In this study, most patients (72.2%) had their nailbed injuries repaired by pediatric emergency doctors. The commonest mechanism of nailbed injury was door crush injuries. Increased awareness and education of the caregivers might help avoid these injuries because the injury mechanism in most of the patients is preventable. Partial nail avulsion with underlying simple laceration of the nailbed was the most frequent type of nailbed injury seen. The complications that were seen after nailbed injuries were fingertip sensitivity (5.3%), split nail deformity (5.3%), infection (3.9%), nonadherence of the nail plate (2%), and hook nail deformity (1%). The predictors for the occurrence of complications after nailbed injury were the type of injury (stellate laceration and severe crushed nailbed injuries) and fracture of the distal phalanx. The predictors for the use of antibiotics after nailbed injury in our patients were the mechanism of injury (crushed in door, sports injury, and road traffic accident) and fracture of the distal phalanx. Age was found to be associated with subungual hematomas and avulsion, whereas female sex was found to be associated with crush injuries. Possessing a robust understanding of the mechanism of injury and the underlying anatomy with a detailed assessment of the nailbed injury is of paramount importance in the management of these patients. An initial thorough assessment and meticulous repair of the nailbed injuries will result in good outcomes with overall few complications.
