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Three Part Question

[In patients presenting with distal finger trauma to the emergency department] is the use of [bedside ultrasonography] accurate in the [detection of a nail bed injury or distal phalanx fracture].

Clinical Scenario

A 25 year old man comes to the ER with an injury to his right ring finger. It is a Monday and the waiting room is full, you wonder if there is a way to diagnosis nailbed injury without removing the finger nail.

Search Strategy

Medline 1966-08/17 using OVID interface, Cochrane Library (2017), and Embase

[(exp ultrasound OR exp ultrasonography OR exp ultrasonics)] AND [(exp nail OR exp nailbed OR nail bed) OR (exp distal phalanx)]

Search Outcome

261 studies were identified; one clinical trial addressed the clinical question

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Gungor F et al June 2016 Turkey	18-65 year old ED patients with blunt trauma of distal finger with subungal hematoma	Prospective cross-sectional pilot study with convenience sampling	Dx performance of POCUS for nail bed injury	Sensitivity = 93.9%; Specificity 100%; NLR = 0.06	Small sample size, convenience sample, 30 patients excluded from trial, inter-observer reliability not measured; children not included
			Dx performance of POCUS for fracture	Sensitivity = 100%; Specificity 98.4%; PLR = 59

Comment(s)

Conventional visualization of the germinal matrix by removing the nail is both invasive and time consuming. Ultrasound appears to be a useful tool to evaluate for nailbed injury in the hands of a trained ER clinician.

Clinical Bottom Line

Ultrasound is both sensitive and specific in detecting nailbed injuries and distal phalanx fractures.

References

1. Gungor F, Akyol KC, Eken C, Kesapli M, Beydilli I, Akcimen M. The value of point-of-care ultrasound for detecting nail bed injury in ED Am J Emerg Med. 2016; 34(9):1850-4