From the Research
The treatment for nail plate avulsion involves gentle cleaning, possible reattachment or trimming of the nail, and wound care with antibiotic ointment and non-adherent dressing, as evidenced by the most recent study 1 which supports a non-operative approach for simple fingernail avulsion injuries in children.
Key Considerations
- For partial avulsion, the nail should be gently cleaned with antiseptic solution like povidone-iodine or chlorhexidine, then the partially detached nail can be reattached if viable or trimmed if damaged.
- For complete avulsion, the nail bed should be thoroughly cleaned, any debris removed, and the wound dressed with antibiotic ointment (such as bacitracin or mupirocin) and a non-adherent dressing like petroleum gauze.
- Pain management typically includes acetaminophen or NSAIDs such as ibuprofen 400-600mg every 6-8 hours.
- Antibiotics (such as cephalexin 500mg four times daily for 7 days) are recommended if there's significant contamination or signs of infection.
Post-Treatment Care
- The wound should be kept clean and dry, with dressing changes every 1-2 days.
- Elevation of the affected digit helps reduce swelling and pain.
- Most nail beds heal within 2-3 weeks, and complete nail regrowth takes 3-6 months for fingernails and 6-12 months for toenails.
Monitoring for Complications
- Patients should be monitored for signs of infection including increasing pain, redness, swelling, or discharge, which would require prompt medical attention, as highlighted in studies such as 2 and 3.
- The choice between surgical and non-surgical approaches may depend on the severity of the avulsion and the presence of complications, with recent studies like 4 suggesting modifications to traditional surgical techniques for better outcomes.
- The study 1 provides evidence for a non-operative treatment approach being non-inferior to surgical refixation for simple fingernail avulsion injuries in children, which can guide treatment decisions in similar cases.