Subungual Foreign Body

Aka: Subungual Foreign Body, Nail Bed Foreign Body, Subungual Foreign Body Removal, Nail Bed Foreign Body Removal

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II. Management

  1. Distal Subungual Foreign Body
    1. Trim nail
    2. Grasp foreign body with forceps and extract
    3. Observe for Subungual Hematoma from Nail Bed Laceration
  2. Proximal Subungual Foreign Body
    1. Digital Block
    2. Elevate nail with Freer elevator to either side of the foreign body
      1. Avoid nail bed injury
    3. Attempt to grasp foreign body and extract without nail removal
      1. If unable, partially clip the nail in a V-Shape over the foreign body
      2. If still unable, See Nail Removal
      3. May remove half the nail plate to access the foreign body if needed
    4. Evaluate for complications
      1. Repair Nail Bed Laceration if present
      2. Careful exam for Retained Foreign Body (consider imaging, e.g. xray of Radiopaque Foreign Body)
      3. Nail Trephination as needed for Subungual Hematoma

III. References

  1. Lin, Gajendran and Orman in Herbert (2016) EM:Rap 16(11): 7-8
  2. Warrington (2025) Crit Dec Emerg Med 39(6): 30

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