Case report of nail bed injury after blunt trauma; what lies beneath the nail?

•Fingertips are easily injured with various extents of soft tissue damage.•Delayed and inadequate treatment of nail bed injuries may cause substantial clinical problems.•The aim of this case report is to increase awareness about nail bed injuries among physicians who often treat these patients.•Absence of a fracture does not exclude nail bed injuries.•Adequate initial assessment and treatment are important to achieve the functional and cosmetic outcomes.

IntroductionA stable, mobile and sensate fingertip is of paramount importance to perform daily tasks and sense dangerous situations. Unfortunately, fingertips are easily injured with various extents of soft tissue damage. Delayed and inadequate treatment of nail bed injuries may cause substantial clinical problems. The aim is to increase awareness about nail bed injuries among physicians who often treat these patients.Presentation of caseWe present a 26-year-old male with blunt trauma to a distal phalanx. Conventional radiographs showed an intra-articular, multi-fragmentary fracture of the distal phalanx. At the outpatient department the nail was removed and revealed a lacerated nail bed, more than was anticipated upon during the first encounter at the emergency department.DiscussionBlunt trauma to the fingertip occurs frequently and nail bed injuries are easy to underestimate. An adequate emergency treatment of nail bed injuries is needed to prevent secondary deformities and thereby reduce the risk of secondary reconstruction of the nail bed, which often gives unpredictable results.ConclusionHowever, adequate initial assessment and treatment are important to achieve the functional and cosmetic outcomes. Therefore awareness of physicians at the emergency department is essential.