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Reevaluating Pediatric Nailbed Injuries: Are We Overtreating Simple Cases?

Evelyn Reed1, Catherine Bautista1, Mackenzie French1

  • 1Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, University of Utah, Salt Lake City, UT.

Journal of Hand Surgery Global Online
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Summary
This summary is machine-generated.

Pediatric nailbed injuries treated conservatively show similar outcomes to surgical repair. This suggests simpler treatments may reduce overtreatment and healthcare costs for common childhood injuries.

Keywords:
nailbed lacerationspediatric fingertip injuries

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Area of Science:

  • Pediatric Orthopedics
  • Trauma Surgery
  • Emergency Medicine

Background:

  • Pediatric fingertip injuries, particularly nailbed lacerations, are common.
  • Current treatment protocols lack consensus, potentially leading to overtreatment.

Purpose of the Study:

  • To identify predictors for successful conservative management of pediatric nailbed lacerations.
  • To evaluate outcomes of different treatment interventions for nailbed injuries.

Main Methods:

  • Retrospective chart review of 239 pediatric patients (0-18 years) with nailbed injuries.
  • Exclusion of patients with Seymour or Salter-Harris fractures; inclusion of those with X-rays and follow-up.
  • Analysis of outcomes (infection, complications) based on treatment: nailbed repair, trephination, or conservative management.

Main Results:

  • No significant differences in infection rates (3%, 0%, 2.9%) or complication rates (0.5%, 0%, 2.9%) among the treatment groups.
  • 182 patients (71%) had distal phalanx fractures, with outcomes analyzed across treatment types.
  • Early outcomes were consistently good regardless of intervention for simple nailbed injuries.

Conclusions:

  • Simple pediatric nailbed injuries demonstrate favorable early outcomes with conservative management.
  • Further prospective studies on conservative treatment for uncomplicated nailbed injuries are recommended.
  • Findings may support reduced subspecialist involvement and emergency department length of stay for these injuries.