The nail apparatus includes the germinal matrix (proximal, produces the nail plate), sterile matrix (distal, adheres to the nail plate), and surrounding nail folds. The nail plate acts as a counter-pressure splint for the fingertip pulp during pinch, and disruption of the nail bed from distal phalanx fractures reduces pinch sensitivity and stability. Subungual haematoma from crush injuries requires trephination for pain relief.
Supports and adheres the nail plate; produces the nail from germinal matrix; the nail plate stabilises the distal phalanx for pinch
Nail bed lacerations from crush or avulsion injuries require microsurgical repair under loupe magnification with fine absorbable sutures to prevent permanent nail deformity. The germinal matrix must be carefully repaired to prevent split nail or absent nail plate formation. Hook nail deformity from fingertip amputation without adequate skeletal support is prevented by maintaining appropriate bone length under the nail bed.
Nail bed disruption from crush injury requiring microsurgical repair to prevent permanent nail plate deformity.
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