Case Discussion
Trephination of the subungual hematoma was performed, and the laceration was repaired using tissue adhesive.
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ACEP Now: August 2025 (Digital)Fingertip Injuries Outcome Assessment Score
| Nail | Normal | 1 |
| Small nail | 2 | |
| Split nail or deformed nail | 3 | |
| Hook nail | 4 | |
| Absent nail | 5 | |
| Finger length | Distal third | 1 |
| Middle third | 2 | |
| Proximal third | 3 | |
| Pulp | Well padded | 1 |
| Pulp atrophy | 2 | |
| Bone | Fracture united (consolidated) or normal | 1 |
| Nonunion | 2 | |
| Bone shortening | 3 | |
| Cosmesis | Satisfactory | 1 |
| Not satisfactory (color mismatch) | 2 | |
| Sensation | <6 mm | 1 |
| 7-10 mm | 2 | |
| Cold intolerance | 3 | |
| Absent sensation/hyperalgesia | 4 | |
| Pain | No pain | 1 |
| Mild | 2 | |
| Moderate | 3 | |
| Severe | 4 | |
| Range of motion | 75%-100% | 1 |
| 50%-74% | 2 | |
| <49% | 3 | |
| Grip strength | 75%-100% | 1 |
| 50%-74% | 2 | |
| <49% | 3 | |
| Ability to work | Regular job | 1 |
| Restricted job | 2 | |
| Unable to work | 3 |
Dr. Marco is professor of emergency medicine at Penn State Health-Milton S. Hershey Medical Center and associate editor of ACEP Now.
References
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- James V, Heng TYJ, Yap QV, Ganapathy S. Epidemiology and outcome of nailbed injuries managed in children’s emergency department: a 10-year single-center experience. Pediatr Emerg Care. 2022;38(2):e776-e783.
- Ortega VHG, Terán AIS. Seymour fracture management and functional outcome assessment: a case report. J Surg Case Rep. 2025;2025(2):rjaf083.
- Hawken JB, Giladi AM. Primary management of nail bed and fingertip injuries in the emergency department. Hand Clin. 2021;37(1):1-10.
- Tos P, Titolo P, Chirila NL, et al. Surgical treatment of acute fingernail injuries. J Orthop Traumatol. 2012;13(2):57-62.
- De Ruiter BJ, Finnan MJ, Miller EA, Friedrich JB. fingertip injuries: a review and update on management. J Am Acad Orthop Surg. 2024. Epub ahead of print.
- Roser SE, Gellman H. Comparison of nail bed repair versus nail trephination for subungual hematomas in children. J Hand Surg Am. 1999;24(6):1166-1170.
- Venkatesh A, Khajuria A, Greig A. Management of pediatric distal fingertip injuries: a systematic literature review. Plast Reconstr Surg Glob Open. 2020;8(1):e2595.
- Edwards S, Parkinson L. Is fixing pediatric nail bed injuries with medical adhesives as effective as suturing: a review of the literature. Pediatr Emerg Care. 2019;35(1):75-77.
- Chiche L, Jeandel C, Lyps C, et al. Fingertip nail bed injuries in children: comparison of suture repair versus glue (2-octylcyanoacrylate) with 1-year follow-up. Hand Surg Rehabil. 2020;39(6):550-555.
- Strauss EJ, Weil WM, Jordan C, Paksima N. A prospective, randomized, controlled trial of 2-octylcyanoacrylate versus suture repair for nail bed injuries. J Hand Surg Am. 2008;33(2):250-253.
- Hawken JB, Giladi AM. Primary management of nail bed and fingertip injuries in the emergency department. Hand Clin. 2021;37(1):1-10.
- O’Shaughnessy M, McCann J, O’Connor TP, Condon KC. Nail re-growth in fingertip injuries. Ir Med J. 1990;83(4):136-137.
- Miranda BH, Vokshi I, Milroy CJ. Pediatric nailbed repair study: nail replacement increases morbidity. Plast Reconstr Surg. 2012;129(2):394e-396e.Erratum in: Plast Reconstr Surg. 2012;129(4):1028.
- Jain A, Greig AVH, Jones A, et al. Effectiveness of nail bed repair in children with or without replacing the fingernail: NINJA multicentre randomized clinical trial. Br J Surg. 2023;110(4):432-438.
- Navaeifar N, Kazemi-Sufi S, Afshar A, et al. Appearance outcomes of repositioned native nail plate as a free graft and artificial nail plate in the reconstruction of the fingertip injuries. J Hand Surg Glob Online. 2023;5(4):454-458.
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