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Reimplantation of the nail root in fingertip crush injuries in children
  1. Russell Boyd, Consultant,
  2. Carole Libetta, Consultant
  1. K Mackway-Jones, Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK;
  1. kevin.mackway-jones{at}man.ac.uk

Abstract

A short cut review was carried out to establish whether reimplantation of the nail improved cosmetic outcome after crush injury to the fingertip in children. Altogether 35 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

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Report by Russell Boyd,Consultant
 Checked by Carole Libetta, Consultant

Clinical scenario

A 2 year old child presents to the emergency department with a crush injury to the left index finger tip. The fingernail has been avulsed from the proximal nail fold. You wonder if surgical reimplantation of the nail root into the proximal fold will produce a better cosmetic result.

Three part question

In [children with fingertip injuries to the nail root] does [surgical reimplantation] improve [cosmetic outcome]?

Search strategy

Medline 1966 to 12/01 using the OVID interface. [(exp adolescence OR exp child OR exp child of impaired parents OR exp child, abandoned OR exp child, exceptional OR exp child, hospitalized OR exp child, institutionalized OR exp child, preschool OR exp child, unwanted OR exp disabled children OR exp homeless youth OR exp infant OR exp only child OR child$.mp OR exp pediatrics OR pediatric$.mp OR paediatric$.mp) AND exp finger injuries AND (fingertip.mp OR finger tip.mp OR nail$.mp) AND (exp replantation OR replantation.mp OR reimplantation.mp OR replace$.mp OR repair.mp)] LIMIT to human AND English.

Search outcome

Altogether 35 papers were identified, of which one was deemed relevant for inclusion (table 1).

Table 1

Comment(s)

The outcome was anecdotally related by the authors to the degree of crush injury to proximal nail fold but no evidence was presented to support this. This is a poor study and more research is needed.

CLINICAL BOTTOM LINE

No good evidence exists to guide current decisions. Local guidelines should be followed.

Report by Russell Boyd,Consultant
 Checked by Carole Libetta, Consultant

References

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