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Closed traumatic finger tip injuries in patients with artificial nails: removal of UV gel and acrylic nails

Published:November 09, 2015DOI:https://doi.org/10.1016/j.ajem.2015.11.014
      Traumatic fingertip injuries are exceedingly common and often times very easy to diagnose based on mechanism and visual inspection [
      • Simon R.R.
      • Wolgin M.
      Subungual hematoma: association with occult laceration requiring repair.
      ]. The presence of artificial nails, however, can mask the presentation of an underlying nail bed injury. In addition, they can theoretically increase the risk of infection in the setting of nail bed laceration over a fracture as artificial nails have been shown to harbor pathogens in a number of studies [
      • Pottinger J.
      • Burns S.
      • Manske C.
      Bacterial carriage by artificial versus natural nails.
      ,
      • McNeil S.A.
      • Foster C.L.
      • Hedderwick S.A.
      • Kauffman C.A.
      Effect of hand cleansing with antimicrobial soap or alcohol-based gel on microbial colonization of artificial fingernails worn by health care workers.
      ,
      • Rubin D.M.
      Prosthetic fingernails in the OR. A research study.
      ]. Although obvious crush injuries result in marked deformity of the digit, more subtle mechanisms may result in a nail bed laceration that presents solely as a subungual hematoma. This finding can be difficult to evaluate in the setting of an artificial nail. Nail removal or trephination is generally recommended in the setting of subungual hematoma of greater than 50% of the nail [
      • Zook E.G.
      Anatomy and physiology of the perionychium.
      ,
      • Patel L.
      Management of simple nail bed lacerations and subungual hematomas in the emergency department.
      ]. A patient with a suspected crush mechanism or with a distal phalanx fracture on radiographs should have the artificial nail removed to fully evaluate the extent of the injury.
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