This study compares the outcomes of fixing nail bed injuries with nail bed repair versus irrigation and dressing alone. The main question this study aims to answer is "Does nail bed repair after nail bed injury lead to better outcomes?"
This study compares two treatment methods for patients with nail bed injuries. The first method is irrigation and dressing. The second method is nail bed repair. Patients will be randomized into one of the two groups and outcomes will be documented in both groups.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
100
1. Block involved digit with 3cc 1% lidocaine injected subcutaneously over volar and dorsal metacarpophalangeal joint 2. Apply tourniquet to base of finger if desired 3. Remove nail using freer/hemostats 4. Irrigate wound with at least 500cc normal saline 5. Repair nail bed laceration with 5-0 chromic or monocryl suture 6. Stent eponychium with native nail or fashion substitute from foil suture packet and secure with 2 sutures 7. Dress finger with bacitracin, xeroform, and 2" kling wrap 8. Splint finger as needed with alumifoam splint (apply splint to volar side of finger so as to avoid pressure to nail bed) 9. Repair any other lacerations as needed
1. If there is a subungual hematoma \>50% of the nail, trephinate the nail plate using an 18G needle 2. Irrigate wound with at least 500cc normal saline 3. Dress finger with bacitracin, xeroform, and 2" kling wrap 4. Splint finger as needed with alumifoam splint (apply splint to volar side of finger so as to avoid pressure to nail bed) 5. Repair any other lacerations as needed
Oxford Nail Score
The Oxford Nail Score assess five cosmetic components marked as binary outcomes composed of nail shape, nail adherence, eponychial appearance, nail surface appearance and presence of a split. The final score is 0-5, where 0 is "least optimal appearance" and 5 is "most optimal appearance."
Time frame: From time of treatment, outcomes will be measured at 1-2 weeks, 6 weeks, 1 year, and 2 years
Subjective Cosmesis
Patients will self-score their cosmesis on a likert scale, with lower scores indicated better cosmesis. This will be scored from 0 to 8.
Time frame: 1-2 weeks, 6 weeks, 1 year, 2 years
NRS Pain score
Patients will rate their nailbed on a 0-10 scale, where 0 is no pain and 10 is the worst pain imaginable.
Time frame: 1-2 weeks, 6 weeks, 1 year, 2 years
Nail regrowth
Nail regrowth will be documented on a binary scale (yes or no) by an evaulator via photo.
Time frame: 1-2 weeks, 6 weeks, 1 year, 2 years
Evidence of infection
Evidence of infection will be evaluated on a binary scale (yes or no) by an evaluator via photo.
Time frame: 1-2 weeks, 6 weeks, 1 year, 2 years
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