Rethinking the Need for Nail Plate Removal: A comparison of the risks between standard nail bed repair and conservative treatment
Vinay Rao, MD, MPH, Ronald A. Akiki, BA, Joseph W. Crozier, MA, Reena A. Bhatt, MD, Scott T. Schmidt, MD, MBA, Loree K. Kalliainen, MD, MA
The Warren Alpert Medical School of Brown University
Background: Nail bed injuries are commonly treated with nail plate removal and repair due to concern for future nail deformity. There is controversy whether this is necessary. We compared the outcomes for adult patients with simple nail bed lacerations who underwent either formal nail bed repair or conservative management.
Methods: A retrospective cohort study was performed of adult patients with presumed nail bed lacerations from 2012 to 2019. Nail bed lacerations were diagnosed in patients with fingertip injuries and either a visible laceration on exam, subungual hematoma (SUH) >50%, or any SUH in the setting of a distal phalanx fracture. All patients included had an intact nail plate. Patients were treated either with nail bed laceration repair or conservatively with splinting without nail plate removal. The primary outcome was the development of a nail deformity. Secondary outcomes included infection, nonunion, and patient reported functional outcomes using the quick DASH survey.
Results: Thirty-eight patients with nail bed lacerations were treated conservatively, and 40 patients were treated with nail bed repair. Average follow-up time was 4.5 weeks in the office and no shorter than 1-year on telephone interview. Patients in the conservative management group exhibited no greater risk for nail deformities compared to the nail bed repair group (13% vs 23%, RR = 0.58, p = 0.40). There were no significant differences in secondary outcomes or quick DASH scores between groups.
Conclusions: This study reports no increased risk for nail deformities in adult patients with simple nail bed lacerations treated conservatively versus those treated with nail bed repair.
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