From the Division of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, RI.
Ann Plast Surg. 2022 May 1;88(3 Suppl 3):S209-S213. doi: 10.1097/SAP.0000000000003197.
Nail bed injuries are commonly treated with nail plate removal and repair due to concern for future nail deformity. There is controversy whether this is necessary. We compared the outcomes for adult patients with simple nail bed lacerations who underwent either formal nail bed repair or nonoperative management.
A retrospective cohort study was performed of adult patients with nail bed lacerations from 2012 to 2019. Nail bed lacerations were diagnosed in patients with fingertip injuries resulting in subungual hematoma greater than 50% or in any subungual hematoma in the setting of a distal phalanx fracture. All patients included had an intact nail plate. Patients were treated with nail bed laceration repair or nonoperatively without nail plate removal. The primary outcome was the development of a nail deformity. Secondary outcomes included infection, fracture nonunion, and patient-reported functional outcomes using the quick Disabilities of the Arm, Shoulder and Hand score.
Thirty-eight patients with nail bed lacerations were treated nonoperatively, and 40 patients were treated with nail bed repair. The average follow-up time was 4.5 weeks in the office. In addition, 1-year evaluation of patients was performed through telephone interview. The patients in the nonoperative group exhibited no statistically significant difference in the calculated risk for nail deformities compared with the nail bed repair group (13% vs 23%, relative risk = 0.58, P = 0.40, 95% confidence interval = 0.42-1.25). There were no significant differences in secondary outcomes or quick Disabilities of the Arm, Shoulder and Hand scores between groups.
The authors observed no meaningful difference in the rate of nail deformities in adult patients who underwent nail bed repair compared with those managed nonoperatively.
由于担心未来指甲畸形，通常会通过去除指甲板并修复来治疗甲床损伤。是否需要这样做存在争议。我们比较了接受正规甲床修复或非手术治疗的成人单纯甲床裂伤患者的结果。
对 2012 年至 2019 年期间患有甲床裂伤的成年患者进行了回顾性队列研究。指尖损伤导致甲下血肿大于 50%或任何在远节指骨骨折的情况下出现的甲下血肿的患者被诊断为甲床裂伤。所有纳入的患者均有完整的指甲板。患者接受甲床裂伤修复或不进行指甲板去除的非手术治疗。主要结局是指甲畸形的发展。次要结局包括感染、骨折不愈合以及使用快速上肢、肩部和手部残疾评分（quick Disabilities of the Arm, Shoulder and Hand score）评估的患者报告的功能结局。
38 例甲床裂伤患者接受非手术治疗，40 例患者接受甲床修复。平均随访时间为 4.5 周。此外，通过电话访谈对患者进行了 1 年的评估。与甲床修复组相比，非手术组的指甲畸形计算风险没有统计学差异（13%对 23%，相对风险=0.58，P=0.40，95%置信区间=0.42-1.25）。两组之间的次要结局或快速上肢、肩部和手部残疾评分没有显著差异。
作者观察到接受甲床修复的成人患者与接受非手术治疗的患者相比，指甲畸形的发生率没有明显差异。
