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Should we replace nail plates after repairing nail bed injuries in children?
  1. Kazuki Iio1,2,
  2. Heather Hanna3,
  3. Rebecca Salter4,
  4. Ian K Maconochie4
  1. 1Applied Paediatrics MSc course, Imperial College London, London, UK
  2. 2Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
  3. 3Section of Paediatric Infectious Disease, Imperial College London, London, UK
  4. 4Paediatric Emergency Department, Imperial College London, London, UK
  1. Correspondence to Dr Kazuki Iio, Applied Paediatrics MSc course, Imperial College London, London, UK; kazukiiio1026{at}

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Clinical scenario

A boy in his early childhood presented to the paediatric emergency department with a fingertip injury. His index finger was caught in the hinge of a door upon its closure. Examination revealed a subluxation of the fingernail and a laceration on the underlying nailbed. After repairing the nailbed laceration, you wonder whether to replace the nail plate or not.

Structured clinical question

In children with nail bed injuries (PATIENT), does replacing the nail plate after repair (INTERVENTION) result in a better cosmetic outcome or lower risk of infections (OUTCOME) compared to discarding the nail plate (COMPARISON)?


A literature search was conducted using MEDLINE, Embase and the Cochrane Library with the following keywords: ‘nail bed injury’, ‘nail bed repair’, ’child’ and ‘paediatrics’. Studies comparing children with nail bed injuries who had their nails replaced and discarded after the procedure were included. Articles written in languages other than English were excluded. The search yielded a total of 58 articles, of which 3 were included as relevant articles. All three studies were conducted in the UK, and two were part of the same research project, which included a pilot study and a subsequent randomised controlled trial.1–3 The results of the review are summarised in table 1.

View this table:
Table 1

Summary of included studies


Refer to table 1 below.


The fingertip is part of the body with a highly sophisticated function in sensing tactile stimuli, acting as the key to intricate human manoeuvres.4 Unfortunately, it is also known as the most common site of injury in children’s hands, accounting for more than two-thirds of paediatric hand trauma.5 It is estimated that around 700 000 children in the USA are treated annually for door-related distal tip injuries and around 10 000 children in the UK are operated on year for fingertip injuries.6 7

What makes the management of …

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  • Contributors KI drafted the initial manuscript. HH, RS and IKM critically revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.