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Three Part Question

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

Clinical Scenario

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

Search Strategy

Medline 1966-12/01 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

35 papers were identified, of which 1 was deemed relevant for inclusion.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
O'Shaughnessy M et al, 1990, Ireland	64 finger tip injuries in patients aged 1-81 years 10 with nails vs 54 without	Retrospective observational	Cosmetic appearance	No difference	Objective scoring mechanism lacking Included both adults and children
			Nail length	No difference

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.

References

1. O'Shaughnessy M, McCann J, O'Connor TP, et al. Nail re-growth in fingertip injuries. Irish Medical Journal 1990;83(4):136-7.