Management of a Crush Injury on Distal Phalanx

 How can we manage a crush injury ? 

Any patient with injury should be managed based on the principles of ATLS 

A,B,C,D and C-spine must be ensured that they are normal.

Relevant history - handedness, occupation, MOI, Co-morbidities

Tetanus Prophylaxis given if indicated. 

Antiseptic Dressing

Wound Exploration 

        repair nail bed under LA 

            (digital block and digital tourniquet )

Steps of procedures 

        Remove nail bed 

        inspect nail bed, wash thoroughly 

        copious lavage of any underlying fractures

        reduce fracture,stabilize with k-wires,removal at 4 weeks

        repair nail bed with a 6-0 absorbable suture (VICRYL Rapide)

        wash and replace nail plate 

        figure of eight stitch to hold nail plate in place 

 What to explain to patient 

    Nail plate falls off and will be replaced which initially disfigures 

    risk of long term nail deformity

    Discomfort in region of nail bed

    DIP Joint stiffness 



        



    

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