Reevaluating Pediatric Nailbed Injuries: Are We Overtreating Simple Cases?

Pediatric fingertip injuries involving the nailbed are extremely common; however, there is no consensus on treatment protocols. The practice of repairing simple nailbed laceration injuries may result in overtreatment. The aim of this study was to identify variables that could predict which patients with nailbed lacerations might achieve equivalent outcomes with fewer procedural interventions.

A retrospective chart review was conducted at a single children's hospital. Patients aged 0-18 years with nailbed injuries were included if they had an x-ray at the time of injury, at least one follow-up appointment, and no Seymour or Salter-Harris fractures. Descriptive statistics were generated. chi-square and Fisher exact tests were used to analyze categorical variables, and the Kruskal-Wallis test was used to analyze continuous variables.

Two hundred thirty-nine patients were included in the study, accounting for 255 nailbed injuries. One hundred thirty-two were men (55%), 107 were women (45%), and the mean age at the time of injury was 6.1 years. The median follow-up was 15.1 days. One hundred eighty-two patients (71%) sustained a distal phalanx fracture. Outcomes were analyzed by the type of nailbed repair (removal and repair, trephination, and conservative). The analysis demonstrated no differences in infection rates among treatment groups: nailbed repair (3%), trephination (0%), and conservative (2.9%), and no difference in complication rates (0.5%, 0%, and 2.9%, respectively).

For simple nailbed injuries, patients had consistently good early outcomes irrespective of the intervention. Further study into long-term outcomes and a prospective investigation into conservative treatment of uncomplicated nailbed injuries are warranted.

These findings may alter practice management in the treatment of simple nailbed injuries. Simple nailbed injuries may be treated conservatively with similar rates of complication, thereby reducing the necessity for subspecialist involvement in these injuries, pediatric procedural sedations, and emergency room length of stay.