The nail, nail bed, and surrounding soft tissue make up the perionychium (see Fig 3.9:1). The nail bed is made up of the germinal and sterile matrix. The germinal matrix begins 3 to 5 mm proximal and deep to the eponychium and extends distally to the lunula. From there, the sterile matrix (responsible for producing the majority of the nail) extends distally to the hyponychium. Injury to the perionychium is most commonly due to closure of the fingertip in a door and often occurs in the distal portion of the nail bed; it may occur as an isolated injury or in combination with any of the injuries previously discussed. Injuries can be described as simple nail bed laceration, stellate laceration, severe crush, and complete avulsion. The mechanism of injury is a force directed to the dorsum of the nail, causing it to bend or break and crushing the nail bed against the unyielding tuft of the distal phalanx. There is an associated distal tuft fracture in approximately 50 percent of nail bed injuries; thus all patients require the standard three radiographic views of the involved digit(s). Nail plate deformity affecting permanent nail growth is the most common complication resulting from lack of treatment. Therefore it is important to recognize when these injuries have occurred and to treat them appropriately.
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