The Use of Bedside Ultrasonography to Detect Nail Bed Injuries
Date First Published:
August 14, 2017
Last Updated:
August 21, 2017
Report by:
Ronald Rasch MD, Matt Flannigan DO, Senior Emergency Medicine Resident (Rasch), EM faculty (Flannigan) (MSU Spectrum Health Emergency Medicine Residency)
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
Search Details:
[(exp ultrasound OR exp ultrasonography OR exp ultrasonics)] AND [(exp nail OR exp nailbed OR nail bed) OR (exp distal phalanx)]
Outcome:
261 studies were identified; one clinical trial addressed the clinical question
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The value of point-of-care ultrasound for detecting nail bed injury in ED Gungor F, Akyol KC, Eken C, Kesapli M, Beydilli I, Akcimen M. Jun-16 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 |
Author Commentary:
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.
Bottom Line:
Ultrasound is both sensitive and specific in detecting nailbed injuries and distal phalanx fractures.
References:
- 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