Is splinting (application of a rigid device to support and immobilize) necessary after fingernail removal?

Splinting After Fingernail Removal

Splinting after fingernail removal is strongly recommended to prevent nail bed contracture, reduce pain, and promote proper nail regrowth. The nail plate itself normally serves as a natural splint for the underlying nail bed, and when removed, a substitute splint should be placed to maintain the space and protect healing tissues.

Why Splinting Is Necessary

• The nail bed requires external support after nail removal to prevent contracture of the nail matrix and nail bed, which can lead to permanent nail deformities 1
• Splinting reduces postoperative pain and allows for direct observation of the healing nail bed when transparent materials are used 1
• Without splinting, the nail fold can collapse onto the exposed nail bed, leading to adhesions and abnormal nail regrowth 2

Splinting Technique and Materials

Preferred Splinting Options:

• Native nail (if available): When the removed nail is intact and clean, it can be replaced as a splint and secured with sutures through the nail fold 3

  • This approach shows significantly fewer nail deformities compared to synthetic alternatives (p < 0.015) 3
  • Results in approximately half the infection rate compared to silicone splints 3

• Flexible plastic tube splint: A longitudinally incised plastic tube (such as an aspiration tube) placed along the lateral nail edge is effective and inexpensive 1, 4

  • Particularly useful for lateral nail bed injuries and ingrown nail procedures 5
  • Can be secured with formable acrylic for fixation 5

• Silicone nail splints: Commercial silicone sheets or INRO surgical nails can substitute when the native nail is destroyed 2

  • Achieved 89% good results in acute nail bed injuries 2
  • However, associated with higher infection rates and more nail dystrophies compared to native nail splints 3

Duration of Splinting

• For intact or minimally damaged nails: Remove splint after 3 days, which is as effective as longer durations with no difference in recurrence rates (7.1% vs 10.3% at 2 weeks) 6
• For significant nail bed repairs: Maintain splinting for 1-2 weeks to allow adequate healing and prevent contracture 1, 6
• Follow-up timing: Evaluate at 1,2, and 4 weeks post-procedure for tissue status and pain level 6

Critical Management Points

• Cover the splinted nail bed with a clean dressing to reduce contamination risk 7, 8
• Ensure adequate padding around the splint to prevent pressure necrosis and allow for swelling 7
• Monitor for infection: Most infections are caused by gram-positive bacteria (Staphylococcus aureus) 3
• Avoid overtight dressings that could compromise circulation 8

Expected Outcomes

• Pain relief is typically immediate after splint placement 4
• Inflammation subsides within one week in most cases 4
• Overall recurrence rate is low (8.7%) when proper splinting technique is used 6
• Cosmetic results are generally excellent with appropriate splinting 1

Common Pitfalls to Avoid

• Never leave the nail bed unsplinted after complete nail removal, as this leads to contracture and permanent deformity 1, 2
• Do not discard the native nail if it's intact—it's the best splinting material available 3
• Avoid using the native nail if heavily contaminated or if there's concern for introducing infection 3