Nail Bed Injuries and Fingertip Injuries with Tissue Loss
DNB Orthopaedics • October 2024 • Paper III • 10 Marks
Introduction
The fingertip is a highly specialized sensory and functional unit composed of the distal phalanx, pulp, nail complex, skin and digital neurovascular structures. Nail-bed injuries are common after crush and sharp trauma and are frequently associated with distal phalanx fractures.
The goals of treatment are to obtain a painless, sensate, stable fingertip with maximum length, adequate padding and a smooth, functional nail.
Key principle
Precise repair of the nail bed is important because irregular healing of the germinal or sterile matrix may produce permanent nail deformity.
A. Anatomy of the Nail Unit
The nail apparatus consists of:
- Nail plate
- Nail bed
- Germinal matrix
- Sterile matrix
- Nail folds
- Eponychium
- Hyponychium
Components and Functions
| Structure | Location / Function |
|---|---|
| Nail plate | Keratinized plate overlying nail bed; provides counterpressure during pinch and protects distal phalanx. |
| Germinal matrix | Proximal matrix beneath proximal nail fold; produces most of the nail plate. |
| Sterile matrix | Distal nail bed; adheres nail plate and contributes a smaller component to nail production. |
| Lunula | Visible pale crescent corresponding to distal germinal matrix. |
| Eponychium | Cuticular tissue sealing proximal nail plate to… |