Management of Nail Blunt Trauma in Pediatric Patients

Indications for Nail Removal

• Nail removal is indicated in pediatric patients with blunt trauma when there is severe pain, a pressure hematoma, or a subungual abscess 1, 2
• Severe and/or painful lesions that significantly impact daily activities require immediate nail removal 1, 2
• Presence of a pressure hematoma under the nail is an indication for nail removal 2, 3
• Subungual abscess formation requires nail removal 1, 4

Management Protocol

• When nail removal is performed, the nail bed should be cleaned thoroughly 2
• Bacterial cultures should be obtained if infection is suspected when nail removal is performed 1, 3
• Any identified infection should be treated with appropriate topical/oral antibiotics and antiseptics when nail removal is performed 2
• Regular nail trimming is necessary until the nail plate grows reattached after nail removal 1, 2

Pitfalls to Avoid

• Failing to remove the nail when indicated can lead to chronic onycholysis and persistent subungual hyperkeratosis 2
• Inadequate cleaning and debridement of the nail bed when nail removal is performed can lead to complications 2