Nail bed injuries in children are a widespread issue, with over 10,000 operations performed each year in the UK alone. Often caused by a child’s fingertip being crushed in a closing door, these injuries were the focus of a 2017 information campaign by BAPRAS (British Association of Plastic Reconstructive and Aesthetic Surgeons) to raise awareness and prevent accidents.
When surgery is required to fix a nail bed tear, there are two main treatment options: either reattaching the original nail or discarding it completely.
Though 96% of surgeons choose to reattach the nail, believing it offers protection, reduces infection, and causes less pain during dressing changes, there has been no concrete evidence supporting this practice. In fact, while numerous papers explain how to reattach the nail, none explain why it should be reattached. This prompted Abhilash Jain, Associate Professor of Plastic and Hand Surgery at the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), Oxford, to question whether this approach had any impact on infection rates and cost-effectiveness compared to discarding the nail.
In a first-of-its-kind study conducted with the Reconstructive Surgery Trials Network (RSTN), researchers set up a randomized controlled trial involving 20 hospital units and 100 surgeons across the UK. A total of 451 children under 16 years old were randomly assigned to groups either replacing or discarding the nail following nail bed injury repair. The primary outcome measured was infection at seven days post-surgery, and a cost-effectiveness analysis has been accepted for publication in the British Journal of Surgery.
Key Takeaways in a Nutshell – Health Newstrack
– Nail bed injuries in children are common, with over 10,000 surgeries performed annually in the UK.
– The main cause of these injuries is a child’s fingertip being crushed in a closing door.
– During surgery, there are two treatment options: reattaching the original nail or discarding it.
– Currently, 96% of surgeons choose to reattach the nail, but there is no concrete evidence supporting this practice.
– A first-of-its-kind study by the Reconstructive Surgery Trials Network (RSTN) involved a randomized controlled trial to compare both treatment options.
– The primary outcome measured was infection rates seven days post-surgery, and a cost-effectiveness analysis has been accepted for publication in the British Journal of Surgery.