Biomedical subjects
Publications and source records attributed to J B Grad.
Injuries in children occur most frequently to their hands and result in a different spectrum of injury than that seen in adults. Basic concepts of the maturing skeleton are discussed along with diagnostic concerns and guiding principles of treatment.
Fingertips are functionally important contact surfaces. Pain-free and stable tissue coverage with good sensibility is needed. The method of repair depends on many factors, as herein discussed, including careful donor site consideration if tissue is transferred for repair. A small injury to a finger can result in prolonged disability and morbidity so that such injuries deserve the same thoughtful consideration, planning, and technical adroitness as do all hand problems.
The primary care physician has a profound influence on the prevention of deformity and disability resulting from fingernail injuries. Prompt recognition and precise repair of the disrupted nailbed consistently result in successful nail restoration. For injuries with a substantial subungual hematoma or a displaced phalangeal fracture, optimal treatment requires removal of the nailplate, reduction of the fracture, and meticulous repair of the nailbed. Even with severely fragmented or avulsion injuries, the results of an accurate primary repair are generally far superior to those of corrective surgery for established fingernail deformities. Skillful primary repair is the best method of managing the vast majority of fingernail injuries.