Nail-bed injury

Nail-bed injuries are the most common fingertip injury seen in the emergency department. The nail bed — the germinal matrix beneath the nail plate — is crushed, lacerated, or avulsed, often with a distal phalanx fracture (a Seymour fracture in skeletally immature patients). If not repaired carefully, scarring of the germinal matrix results in a permanently deformed, split, or absent nail.

The nail plate itself acts as a protective splint and, when intact, is often left in place or replaced over the repair.

Clinical inspection under adequate lighting (with a digital block if needed). X-ray of the finger is mandatory to identify a distal phalanx fracture — an open fracture in association with a nail bed injury requires urgent irrigation and debridement.

Any nail bed laceration, avulsion, or nail bed injury associated with distal phalanx fracture requires formal repair under magnification.

External patient-education references and related OSI pages for additional background:

• Britannica — Hand (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language